Condition- Parkinson's

Question 1

What is parkinson’s disease and what 4 symptoms is it characterised by?

Answer 1

Neurodegenerative disease of dopaminergic neurones of substantia nigra

• Bradykinesia- difficulty initiating movement
• Tremor- 3-5Hz, worse with stress, better with movement
• Rigidity - cogwheeling/ lead pipe
• Postural instability- shuffling gait, reduced arm swing

Question 2

Describe what happens to the brain in parkinsons

Answer 2

Degeneration of dopaminergic neurones projecting from the substantia nigra (SNc) to the striatum in the basal ganglia – due to mitochondrial DNA

Question 3

Name a distinct histological feature of parkinsons

Answer 3

Intracytoplasmic Lewy Bodies

Question 4

Describe what happens to the basal ganglia neurological pathway to bring about the inhibitory effect which characterises Parkinsons

Answer 4

Decreased direct pathway

increased indirect pathway

= increased inhibitory activity from Globus pallidus interna/ SNr to thalamus

= decreased cortical activation

Question 5

List some of the risk factors for developing PD

Answer 5

AETIOLOGY is UNKNOWN

• Age
• Familial PD
• Some genetic mutations: MPTP

Genetic predisposition with environmental exposure

Question 6

Describe the onset of PD

Answer 6

INSIDIOUS onset

Question 7

List some of the presenting motor symptoms of Parkinsons

Answer 7

MOTOR:

TREMOR:

• Resting tremor (mainly in hands) – one side worse

RIGITDITY:

• Stiffness and slowness of movements
• Loss of dexterity and smaller hand writing (micrographia)

BRADYKINESIA:

• Difficulty initiating movements

POSTURAL INSTABILITY:

• Frequent falls

Question 8

List some of the presenting non-motor symptoms of Parkinsons

Answer 8

NON-MOTOR:

PSYCHOLOGICAL/ COGNITIVE

• Insomnia
• Mental slowness (bradyphenia)
• visual hallucinations
• depression

AUTONOMIC:

• sense of smell reduced
• constipation
• frequency/urgency
• dribbling of saliva

Motor –> autonomic–> psychological

Question 9

List some of the motor signs of PD

Answer 9

Tremor

• Pill rolling rest tremor
• 4-6 Hz
• Decreased on action
• Usually asymmetrical

Rigidity- do the hand circle test

• Lead pipe (as opposed to glass pipe) rigidity of muscle tone
• Superimposed tremor can cause cogwheel rigidity
• Rigidity can be enhanced by distraction

Gait- by observation

• Stooped
• Shuffling
• Small-stepped gait
• Reduced arm swing
• Difficulty initiating walking

Postural Instability- do pull test

• Falls easily with little pressure from the back or the front

Question 10

Which investigations could you order for someone with parkinsons?

Answer 10

• MOSTLY CLINICAL DIAGNOSIS
• To confirm diagnosis Levodopa trial: timed walking + clinical assessment after administering levodopa
• To exclude:
  
  • MRI/CT
  • Bloods (look for serum caeruloplasmin to rule out Wilsons)