29 Parkinson's disease

Question 1

Define Parkinson’s

Answer 1

A progressive neurological disorder defined by presences of bradykinesia, tremor, rigidity, postural instability

Question 2

Epidemiology of Parkinson’s

Answer 2

2% of people over 65 have PD
8% of those develop it before they are 40
Average duration from diagnosis to death is 13 years

Question 3

Describe the pathology of PD

Answer 3

A accumulation of abnormally folded alpha synuclein proteins. Accumulations are called Lewy bodies or Lewy nitrates (depending on where they are in neuron). The aggregations cause neuronal degeneration

Question 4

Where do degenerating neurons occur mostly

Answer 4

In the substantia nigra. Advances topographically in a predictable sequence- motor nucleus of vagus nerve, olfactory bulb

Question 5

Describe pathogenesis

Answer 5

Idiopathic, genetic susceptibility, toxin exposure, infections

Question 6

What is prion hypothesis

Answer 6

That the alpha synuclein is the infectious agent. Disreputed.

Question 7

Cardinal features

Answer 7

Rest tremor
Bradykinesia
Rigidity
Postural abnormalities

Question 8

Describe diagnosis

Answer 8

Clinical diagnosis only.
Two or more of the cardinal features (in absence of other neuropathology)
Progressive course
Responds to L - Dopa

Question 9

Other clinical features

Answer 9

Anosmia
Constipation (vagus nerve)
Pain
REM sleep behaviour disorder, acting out dreams

Question 10

Late complications

Answer 10

Cognitive abnormalities (confusion, hallucination, dementia)
Emotional disturbances (anxiety, depression)
Postural hypotension
Fluctuations in dyskinesias (due to half life of drugs)

Question 11

Drug treatment

Answer 11

L-Dopa
Dopamine agonist
Anticholinergics

Question 12

Surgical treatments

Answer 12

Stereotactic pallidotomy
Transplantation of dopamine producing tissue (fetal tissues)
DBS, stunning the sub thalamic nucleus.