Clinical Lecture: Parkinson's disease

Question 1

What is Parkinsonisim?

Answer 1

Parkinsonisim is a clinical syndrome comprising of:
- Bradykinesia

And one of the following:

• Tremor
• Rigidity
• Postural Instability

Question 2

What is the most common cause of Parkinsonisim?

Answer 2

Parkisnon’s Disease. It is defined histopathological. Due to specific pathology on brainstem and basal ganglia. Lew body bodies build up and neuronal degeneration. It has certain features - asymmetry, sustained response to Levodopa etc.

Other causes include:

• Neurodegenertaive conditions such as Dementia with Lower bodies, Progressive supranucelar Palsy etc.
• Dopamine induced e.g. using dopamine agonist most commonly ant-emetics and anti-psycotics
• Vascular
• Metabolic - Wilson’s disease

Question 3

What are risk factors for PD?

Answer 3

• Advancing age - less than 5% diagnosed under 40 years. More likely in this case to fine a single gene cause
  
  • Male > Female 3:2
  • Caucasians
  • Rural living and farmers; pesticides?
  • FH

Question 4

Give pathological hallmarks fo PD.

Answer 4

• Early degeneration and death of dopamine neurones within the Substantia nigra pars compacta of the basal ganglia
  
  • Alpha synuclein - abnormal protein - packaged in a Lewy body. The protein misfolds and becomes fibril and no longer soluble.

Question 5

Give non-motor features of PD.

Answer 5

• Anosmia – lack of sense of smell
• Sleep disturbance – excessive sleep or REM sleep behavior disorder
• Depression and anxiety
• Cognitive issues – mild cognitive impairment, dementia
• Psychotic symptoms – visual hallucinations and delusions
• Constipation
• Urine issues – hyperexcitability
• Postural hypotension
Pain

Question 6

What is a complication of PD seen in 50% after 10 years?

Answer 6

Dementia