Parkinson's disease Flashcards
What is onset of Parkinson’s?
- insidious onset
2. chronic progressive
What is mean age on onset for Parkinson’s disease?
60years
What is the distribution for Parkinson’s?
asymmetrical
What are RF for parkinson’s disease?
- Increasing age
- Hx of familial PF in younger onset disease
- Mutation in gene encoding glucocoerberosidase
- MPTP exposure
What is the pathophysiology of Parkinson’s disease?
- Loss of dopaminergic neurons in substantia nigra
2. Lewy bodies in basal ganglia, brainstem and cortex
What are the signs and symptoms of Parkinson’s disease?
- Resting tremor
- Rigidity: cogwheel (hypertonia)
- Bradykineasia: slow to intiate movement
- Postural instability
- Autotomic dysfunction
What is the resting tremor like in PD?
4 to 6 Hz tremor at rest, asymmetrical, pillrolling over thumb and fingers
What are signs of autonomic dysfunction?
postural hypotension, constipation, urinary urgency and dribbling of salvia
What are possible DDx of PD?
- Essential tremor
- Progressive supranuclear palsy (PSP)
- Multiple system, atrophy
- Lewy body dementia
- Alzheimer’s disease with parkinsonism
- Drug-induced parkinsonism (symmetrical and Hx)
What investigation should you do in PD?
dopaminergic agent trial: improvement in symptoms
What other investigations can you consider for PD?
- MRI brain to rule out structural
- If symmetrical think of other pathology
What is the 1st line treatment for PD?
- MAO-B inhibitor
- dopaminergic agent
- amantadine
- trihexyphenidyl
e. g. levodopa or rasagiline
What are other possible treatments for PD?
- Deep brain stimulation (with refractory tremor)
- Additional Carbidopa
- COMT inhibitor
What are possible complications of PD?
- Levodopa-induced dyskinesias
- Motor fluctuations
- Dementia
- Constipation
- Psychosis
- Depression
- Anxiety
- Impulse control disorder
What is the patho of Parkinson’s disease?
- Misfolded alpha synuclein builds up
2. Lewy bodies and Lewy neutrites
What goes under ‘parkinsinosm’?
- Parkinson’s
- Drug induced
- Atypical Parkinsonisms
What are the 6 M’s of Parkinson’s?
- Monotonous, hypotonic speech
- Micrographia
- March a petit pas
- Misery (depression)
- Memory loss (dementias)
- HypomiMesis
What are different types of gait?
- Ataxic
- Hemiplegic
- Scissor gate
- Choreiform
- Shuffling
What is ataxic gait assoicated with?
erebellar sign, seen in Wernicke’s encephalopathy
What is hemiplegic gait assoicated with?
stroke
What is scissor gait associated with?
cerebral palsy
What is choreiform gait associated with?
Huntington’s
What is shuffling gait associated with?
Parkinsons
What are different types of atypical parkinsonisms?
- multiple system atrophy (MSA)
- progressive supranuclear palsy (PSP)
- corticobulbar degeneration
- vascular parkinsonism
- lewy body dementia
What is MSA associated with?
early autonomic and cerebellar features and Papp-Lantos bodies
What is PSP associated with?
early postural instability and vertical gaze palsy
What is corticobulbar degeneration associated with?
alien limb phenomenon
What is vascular parkinson associated with?
Legs particularly affect and gait worse than tremor
What is Lewy body dementia associated with?
early dementia and visual hallucinations
