Parkinson's disease

Question 1

What is Parkinson’s disease?

Answer 1

A movement disorder characterised by: tremor at rest, rigidity, bradykinesia (Slowness of movement and increasing slowness of movement over constant movement)

Question 2

Describe the aetiology of Parkinson’s disease

Answer 2

1% of people over 65 are affected
Median age of onset is 60 years old

Question 3

What are some risk factors for Parkinson’s disease?

Answer 3

• Increasing age
• Positive family history
• Male gender
• Environmental factors
• Genetic factors

Question 4

What are some environmental factors that increase risk of Parkinson’s disease?

Answer 4

Pesticide exposure
Prior head injury
Rural living
ß-Blocker use
Well-water drinking

Question 5

What are some factors that may decrease risk of Parkinson’s disease?

Answer 5

Tobacco smoking
Coffee drinking
NSAID use
Ca2+ channel blocker use
Alcohol consumption

Question 6

Describe the pathology of Parkinson’s disease?

Answer 6

Parkinson’s disease is caused by loss of domaminergic (Inhibitory) cells in the substantia nigra and locus coeruleus

Question 7

What are the main sub-types of motor symptoms in Parkinson’s disease?

Answer 7

Tremor dominant
Non-tremor dominant
Mixed

Question 8

What are some motor symptoms of Parkinson’s disease?

Answer 8

Bradykinesia
Resting tremor
Rigidity
Postural and gait impairment

Question 9

What is bradykinesia?

Answer 9

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

Question 10

What is a resting tremor?

Answer 10

Rhythmic oscillatory involuntary movement of affected body part at rest

Often described aspill-rollingbecause the patient appears to be rolling something between thumb and forefinger

Question 11

What is rigidity?

Answer 11

Stiffness on passive limb movement is described as ‘lead pipe’, as it is present throughout the range of movement and, unlike spasticity, is not dependent on speed of movement

Question 12

What are some signs of postural and gait impairment in Parkinson’s disease?

Answer 12

• Stooped posture owing to impaired postural reflexes (major contributor to falls risk)
• Gait gradually becomes shuffling
• Reduced arm swing during movement

Question 13

What are some non-motor symptoms of Parkinson’s disease?

Answer 13

• Sleep disorders
• Hallucinations
• GI dysfunction
• Depression
• Cognitive impairment/dementia
• Anosmia (Loss of smell) - May be a prodrome of Parkinson’s disease
• Issues with speech and swallowing

Question 14

What are some issues in speech and swallowing that can occur in Parkinson’s disease?

Answer 14

• Speech becomes quiet, indistinct and flat
• Drooling
• Swallowing difficulty is a late feature that may eventually lead to aspiration pneumonia as a terminal event

Question 15

How is a diagnosis of Parkinson’s disease made?

Answer 15

• Parkinsonism
• No alternative explanation
• Responds to dopamine
• No tests usually required (DaTSCAN may be used)

Question 16

How is DaTSCAN used in Parkinson’s disease?

Answer 16

May show some changes, however, these are not specific to Parkinson’s

Question 17

What are some pharmacological management options for motor symptoms in Parkinson’s disease?

Answer 17

Dopamine replacement therapy

Question 18

What are some drugs used as dopamine replacement therapy in Parkinson’s disease?

Answer 18

Levodopa
Dopamine agonists
Monoamine oxydase type B inhibitors

Question 19

What are some possible management options for tremor in PD?

Answer 19

Anticholinergic agents
Trihexyphenidyl
Clozapine

Question 20

What are some pharmacological management options for non-motor symptoms of PD?

Answer 20

SSRIs for depression
Osmotic laxatives for constipation
Amantadine for dyskinesia