Parkinson's Disease

Question 1

What is Parkinson’s?

Answer 1

Parkinson’s Disease (PD) is a progressive neurodegenerative disease characterised by reduced production of dopamine within the substantia nigra

Question 2

What are the 2 sub-types of PD?

Answer 2

Tremor dominant PD
Nontremor-dominant PD

Question 3

What is tremor dominant PD and non-tremor dominant PD?

Answer 3

Tremor-dominant PD has a relative absence of other motor symptoms, whereas nontremor-
dominant PD presents with akinetic-rigid syndrome and postural instability gait disorde

Question 4

What is the average age of diagnosis of PD?

Answer 4

Age 60 is the average age at which someone receives a diagnosis, although 1 in 20 of those with Parkinson’s is under 40 at time of diagnosis

Question 5

How is PD diagnosed?

Answer 5

Diagnosis is achieved through taking a history, observation, and physical examination, as there is no
scan or biomechanical test to confirm diagnosis. There is a process, developed by the UK Parkinson’s Disease Society Brain Bank, for identifying clinical diagnostic criteria of PD

Question 6

What are the phases of PD?

Answer 6

Preclinical
Prodromal
Symptomatic

Question 7

What is the preclinical phase of PD?

Answer 7

the preclinical period where no symptoms are yet evidend, although some neuroinflammation may be present

Question 8

What is the prodromal phase of PD?

Answer 8

The prodromal period is the second phase which can last months or years, where generalised symptoms such as depression, anxiety, constipation, REM behaviour disorder, and fatigue may appear.

Question 9

What is the symptomatic phase of PD?

Answer 9

The third phase is the symptomatic period when the common motor PD symptoms present and are followed by the non-motor symptoms.

Question 10

What is the causes of the symptoms in PD?

Answer 10

Reduced dopamine within the basal ganglia results in poor speed and quality of motor movements, postural stability, cognitive skills, and affective expression. There are also changes noticed in other neurotransmitters, such as serotonin, noradrenaline, glutamate and GABA, although the mechanism by which these impact on PD is uncertain

Question 11

What is the involvement of Lewy bodies in PD?

Answer 11

Development of abnormal protein folds within cell-bodies and neurons (Lewy bodies) also occurs, although more slowly. They begin within peripheral nervous system and progress through the pons, spinal cord grey matter, midbrain, basal forebrain, limbic system, thalamus, and temporal cortex, finally affecting multiple cortical regions of the brain

Question 12

When are signs and symptoms present in PD?

Answer 12

Signs and symptoms may be noticed slowly over time, e.g. 5-20 years, and only understood as PD once a diagnosis has been made

Question 13

What brain region is involved with motor symptoms of PD?

Answer 13

The basal ganglia is involved in the performance of well-learnt voluntary and semi-automatic motor skills or patterns of movement

Question 14

What is akinesia?

Answer 14

Poverty of movement

Question 15

What is bradykinesia?

Answer 15

Slowness of movement

Question 16

What is hypokinesia?

Answer 16

reduced scaling of movements, affecting many motor activities, including balance, co- ordination, speech, swallowing, handwriting, and facial expression.

Question 17

What is dyskinesia?

Answer 17

involuntary movements, hypothesised to be brought about by long-term use of medications for treatment of Parkinson’s

Question 18

What is Rigidity?

Answer 18

raised and sustained high muscle tone and stiffness, which may initially be asymmetrical, or limited to certain muscle groups.

Question 19

What is rest tremor?

Answer 19

involuntary fine movements which usually begin in one hand or leg (Only
affecting about 70% of those with PD)

Question 20

What is postural instability?

Answer 20

balance and gait problems developing over time

Question 21

What are the non-motor symptoms associated with PD?

Answer 21

• Autonomic failure – hot and cold flushes, postural hypotension (a falls
  risk factor)
• Pain – may be intense and prolonged related to muscle rigidity, may include dystonic muscle cramp
• Continence problems – related to autonomic failure and can include constipation, frequency or urgency of urine, incomplete bladder emptying (a risk factor for bladder infection), nocturia
• Sleep and night-time problems –insomnia, sleep fragmentation, vivid or disturbing dreams, REM sleep disorder, restless legs, nocturia
• Cognitive changes – dysexecutive- type problems, visuo-spatial disturbances
• Sexual health issues – erectile dysfunction, reduced libido, hypersexuality may develop as a side- effect of medication
• Emotional and neuropsychiatric problems
• Fatigue – rapid onset following relatively short periods of activity or sustained use of a particular muscle group
• Dementia – generally only occurring in the later stages of PD

Question 22

What is the medical management of PD?

Answer 22

Current management is through use of medications to increase levels of dopamine within the brain, stimulate parts of the brain where dopamine binds, and blocking the actions of other neurotransmitters such as enzymes which break down dopamine.
Medication regimes should be regularly reviewed and adjusted, and can drastically reduce symptoms, however over time may become less effective with an increased time for absorbed dose
to take effect and wearing off sooner than previously experienced.
The standard drug prescribed for managing symptoms of PD is Levodopa.