Parkinson's Disease

Question 1

What is Parkinson’s disease?

Answer 1

Neurodegenerative condition caused by loss of dopaminergic neurons from the substantia nigra and surviving cells contain inclusions called Lewy bodies

Question 2

Who gets Parkinson’s?

Answer 2

• One of the most common neurodegenerative diseases
• More common with advancing age (over 70)
• Men more common
• Fam history (early before 40= genetic)

Question 3

General presentation of Parkinson’s?

Answer 3

• Motor features in PD are heterogenous but broadly 2 types
• Motor symptoms
• Non-motor symptoms

Question 4

Presentation of Parkinsons?

Answer 4

• Almost always with motor symptoms of tremors and slowness
• Non-motor symptoms= Anosmia, depression and anxiety, REM sleep behaviour disorder =, restless leg syndrome, urinary urgency, hypotension and constipation

Question 5

What are motor symptoms?

Answer 5

• Unilateral onset
• Tremor (typically starts as pin-rolling tremor)
• Rigidity (can be cogwheel or lead-pipe)
• Akinesia/bradykinesia
• Postural instability
• Speech and swallowing difficulty

Question 6

What is akinesia/bradykinesia?

Answer 6

-Slowness of movement with progressive loss of amplitude or speed during attempted rigid alternating movement of body segments

Question 7

Non-motor symptoms?

Answer 7

• Sleep disorders
• Hallucinations
• GI dysfunction
• Depression
• Cognitive impairment/dementia
• Anosmia

Question 8

Diagnosing Parkinsons?

Answer 8

• Clinical diagnosis
• Parkinsonism
• No alternative explanation
• Dopamine Transporter Imaging using SPECT or PET scan can be useful to visualise dopamine transporter levels

Question 9

Cogwheel rigidity?

Answer 9

Jerky rigidity associated with tremor

Question 10

Lead-pipe rigidity?

Answer 10

Smooth. continuous rigidity

Question 11

Examination for Parkinson’s?

Answer 11

• Look at features of their gait
• Masked like expression due to lack of facial movement
• Micrographia (write really small)
• Froment’s manoeuvre

Question 12

What is Froment’s manouevre?

Answer 12

Rigidity increases in examined body segment by voluntary movement of contralateral body parts

Question 13

What type of symptoms does Parkinson’s disease cause?

Answer 13

Extrapyramidal symptoms:

-These originate out with the pyramidal tract (which allows voluntary movement)

Question 14

Dumbed down explanation of Parkinson’s disease symptoms?

Answer 14

Extra movement which isn’t wanted

When movement is wanted, it is slow to initiate

Question 15

General management of Parkinson’s?

Answer 15

• Education
• Encourage physical activity
• Treatment of non-motor symptoms

Question 16

Treatment of motor symptoms- not agonists?

Answer 16

Dopamine therapy- LEVODOPA

Converted in the brain into dopamine

Question 17

Motor complications of Levodopa?

Answer 17

• Motor fluctuations
• Dyskinesia
• Need for higher doses to get same effect
• On, off phenomena

Question 18

Dopamine therapy that is agonistic?

Answer 18

Mimic the effect of dopamine but aren’t converted to dopamine like L Dopa

Question 19

First line treatment for anyone who has Parkinson’s disease with motor symptoms affecting quality of life?

Answer 19

Levodopa

Question 20

What does parkinsonism encompas?

Answer 20

An condition that causes TRAP 
-Tremor, 
-Rigidity, 
-Akinesia/bradykinesia
-Postural disturbances  
(all extra-pyramidal symptoms

Question 21

What can cause parkinsonism?

Answer 21

Anything that causes a relative dopamine deficiency in nigrostriatal pathway

Eg: antipsychotic drugs which block the D2 receptors and therefore can cause parkinsonism as well as other EPSEs

Question 22

What is Parkinson’s disease dementia?

Answer 22

Those who develop dementia >1 year after PD diagnosis.

Dementia with LBs is dementia as a presenting complaint or within 1 year of PD diagnosis