Parkinson's

Question 1

summarise the common signs of parkinsons?

Answer 1

Shuffling gait

Mask- like face

Akinesia

Rigidity

Tremor

Question 2

Define Parkinson’s?

Answer 2

neurodegenerative disease of dopaminergic neurones of the substantia nigra-> characterised by

• bradykinesia
• rigidity
• resting tremor
• postural instability

Question 3

describe the pathophysiology of parkinson’s?

Answer 3

degeneration of dopminergic neurones projecting from substantia nigra to striatum-> due to mitochondrial DNA dysfunction

patients symptomatic after loss of more than 70% of dopaminergic neurones

Question 4

what are the risk factor’s for parkinson’s disease?

Answer 4

increasing age

history of familial PD in younger onset disease

Mutation in gene encoding glucocerebrosidase

MPTP exposure

male

head trauma

geographic influence

toxin exposure

Question 5

what is secondary parkinsonism?

Answer 5

Secondary parkinsonism is when symptoms similar to Parkinson disease are caused by certain medicines, a different nervous system disorder, or another illness. Parkinsonism refers to any condition that involves the types of movement problems seen in Parkinson disease.

Question 6

outline the aetiology of parkinson’s disease?

Answer 6

sporadic/ idiopathic parkinson’s disease

• most common
• unknown aetiology
• may be related to environmental toxins and oxidative stress

There are familial forms of Parkinson’s disease

Question 7

what are the causes of secondary parkinsonism?

Answer 7

• Neuroleptic therapy (e.g. for schizophrenia)
• Vascular insults (e.g. in the basal ganglia)
• MPTP toxin from illicit drug contamination
• Post-encephalitis
• Repeated head injury
• Manganese or copper toxicity (Wilson’s disease)
• HIV

Question 8

summarise the epidemiology of parkinson’s disease?

Answer 8

• Very COMMON
• Prevalence: 1-2% of > 60 yrs
• Mean age of onset: 57 yrs

Question 9

what are the presenting symptoms of parkinson’s disease?

Answer 9

INSIDIOUS onset

Resting tremor (mainly in hands) – one side worse

Stiffness and slowness of movements

Difficulty initiating movements

Frequent falls

Smaller hand writing (micrographia)

Insomnia

Mental slowness (bradyphenia)

Subtle: sense of smell reduced, constipation, visual hallucinations, frequency/urgency, dribbling of saliva, depression

Question 10

what are the signs of parkinsons on physical examination?

Answer 10

Question 11

what are the appropriate investigations for parkinson’s disease?

Answer 11

Levodopa Trial-> Timed walking and clinical assessment after administration of levodopa

=> shows improved symptoms

Question 12

what are the other investigations for parkinson’s?

Answer 12

Bloods

• Serum caeruloplasmin - rule out Wilson’s disease as a cause of Parkinson’s disease

CT or MRI Brain

• To exclude other causes of gait decline (e.g. hydrocephalus)

Dopamine Transporter Scintigraphy

• Reduction in striatum and putamen

Functional neuroimaging

• Helpful in distinguishing between neurogen parkinsonian disorder from vasc, drug-induced or psychogenice parkinsonism
• DaTscan is a tool used to confirm the diagnosis of Parkinson’s disease. It is a specific type of single-photon emission computed tomography (SPECT) imaging technique that helps visualize dopamine transporter levels in the brain.
• decreased basal ganglia (putaminal) pre-synaptic dopamine uptake

Olfactory testing

Genetic testing – may be useful if young onset/ significant FH