Parkinson's Disease Flashcards
What is Parkinson’s disease (PD)?
A slowly progressive degenerative disorder causing impaired motor functions with slow movements, tremor, gait and balance
What is the epidemiology of PD?
Usually between 55-65 years
1-2% of people > 60 (rises to 3.5% between 85-89 years)
0.3% in general population
M > F(1.5:1)
What is the aetiology of PD?
Usually idiopathic but can be due to:
- Genetic (mutation in PINK1, PARKIN, ALPHA SYNUCLEIN genes)
- Toxic impurity – MPTP (found in MPPP a synthetic opioid)
Which protein is important to remember for PD?
Alpha synuclein
What are the risk factors for PD?
*Exposure to certain pesticides/cleaning products
*Age (>60 years)
*Hx of head trauma
*Exposure to heavy metals
Describe the pathogenesis of PD
Loss of dopamine producing cells of the substantia nigra
These cells contain melanin, hence the name
SIDE NOTE : Etymology
Substantia (L) = substance
Nigra (L) = black
What are the early symptoms of PD?
Depression + anxiety (45% of pts)
Reduced appetite
Hypomimia (i.e., blunted affect)
Micrographia (i.e., small writing)
Weight loss
Difficulty with fine motor movements (e.g., buttoning shirt)
Slow monotonous speech
Difficulty swallowing
Tiredness, aches and pains
What are the later symptoms of PD?
Constipation
Bladder symptoms and sometimes incontinence
Hallucinations (esp. visual)
Sweating
Sexual difficulties
Alteration in sense of smell
Sleep disturbance
Weight loss
Difficulty controlling impulses
Memory loss (is patient also has Lewy-Body Dementia)
N.B. - early falls in PD is a red flag
What signs should you look out for in PD?
(TRAP)
Tremors (resting) – 4-6Hz
Rigidity (especially cogwheel rigidity)
Akinesia (esp. bradykinesia)
Postural instability (i.e., difficulty with balance)
Also:
Low mood
Shuffling gait
List some DDx for PD
Benign essential tremor
Drug/toxin induced
Huntington’s disease
Wilson’s disease
Creutzfeldt-Jakob disease
Stroke
Dementia with Lewy body
Pick’s disease (a.k.a FTD)
Parkinsonism secondary to medications (e.g., typical antipsychotics)
Cerebellar tremor
Psychogenic tremor
List some DDx for PD
Benign essential tremor
Drug/toxin induced
Huntington’s disease
Wilson’s disease
Creutzfeldt-Jakob disease
Stroke
Dementia with Lewy body
Pick’s disease (a.k.a FTD)
Parkinsonism secondary to medications (e.g., typical antipsychotics)
Cerebellar tremor
Psychogenic tremor
What is the Mx of PD?
NICE guidelines
1st line = levodopa (if motor symptoms affective QoL) combined with carbidopa (co-careldopa) or benserazide (co-beneldopa).
If motor symptoms not affecting QoL = either levodopa or monoamine oxidase B (MAO-B) inhibitors
Do not offer ergot-derived dopamine agonists as first-line treatment for Parkinson’s disease (N.B. ergot is a fungi from which dopamine agonists were originally produced from)
To whom should you offer adjuvant therapy and when?
Who = pts with dyskinesia or motor fluctuations despite optimal dopamine Tx
When = after discussion with pt about clinical (e.g., PD symptoms, comorbidities and polypharmacy risk) and lifestyle circumstances + harms and benefit of the drug
What adjuvant therapy can be offered to patients?
MAO-B inhibitors
Catechol‑O‑methyl transferase (COMT) inhibitors
True or False
Patients placed on levadopa should be warned about the increased risk of gambling?
True
