Parkinson's and Extrapyramidal Disorders

Question 1

What is the clinical triad of parkinsonisms?

Answer 1

Bradykinesia
Resting tremor (pill rolling)
Rigidity (cogwheel)

Question 2

What is the pathological basis behind parkinson’s disease?

Answer 2

Dopamine depletion in the substantia nigra resulting in disruptions in the connections to the thalamus and motor cortex.

The cause is unknown.

Question 3

Describe the common clinical features/presentation of Parkinson’s disease?

Answer 3

Usually occurs in older people with the peak incidence between 55-65years of age.

Onset is insidious and may initially present with reduced dexterity or a fixed facial expression.

Main clinical features are:

• a resting tremor (if not present may be induced by concentration aka reciting months of the year backwards)
• bradykinesia
• rigidity (cogwheeling, particularly to passive movement)

A shuffling gait is another common feature which is often seen later.

Question 4

Describe some of the early non motor features of Parkinson’s disease?

Answer 4

Often precede motor symptoms of parkinson’s:

• Loss of sense of smell
• Constipation
• Depression
• Rapid eye movement sleep disorder (act out dreams)

Question 5

Describe the broad categories which the non motor features of Parkinson’s disease?

Answer 5

Autonomic dysfunction.

Cognitive and psychiatric symptoms

Sleep disorders.

Question 6

Describe some of the more common non motor features of Parkinson’s disease?

Answer 6

Autonomic:

• Loss of smell.
• Constipation
• Postural hypotension.
• Drooling, difficulty swallowing and speaking (requiring SALT)

Cognitive and psychiatrics:

• Cognitive dysfunction and dementia occurs in 70% eventually (late complication)
• Hallucinations
• Depression (precedes motor symptoms in 30%

Sleep disorders:

• Rapid eye movement sleep disorder
• Excessive daytime sleepiness
• Insomnia

There are many more but these are some of the more common non motor symptoms

Question 7

Describe how dementia in Parkinson’s presents?

Answer 7

Dementia occurring more than one year after a diagnosis of Parkinson’s otherwise classified as Lewy Body dementia.

Presents similarly to lewy body:

• Memory impairment
• Parkinsonisms in limbs
• Visual hallucinations
• Frequent fluctuations into lucidity

Question 8

What is the pathogenesis behind non motor symptoms in Parkinson’s disease?

Answer 8

Widespread neuronal degeneration in the brainstem.