Parkinson's Disease

Question 1

What is Parkinson’s disease.

Answer 1

Degeneration of the dopaminergic neurons of the substantia nigra.

Question 2

What are the causes/associations with Parkinson’s disease. (5)

Answer 2

Increased incidence in males. 
Rural living. 
Exposure to well water. 
Positive family history. 
Drug induced parkinsonianism - not PD, but similar symptoms.

Question 3

What is a cause of drug induced parkinsonianism.

Answer 3

Commonly caused by neuroleptics.

Question 4

What are the clinical features of PD. (17)

Answer 4

Resting tremor. 
Rigidity. 
Bradykinesia. 
Masked facies. 
Stooped posture. 
Micrographia. 
Hypophonia. 
Shuffling gait. 
Instability. 
Visual hallucinations. 
Frequency/urgency. 
Dribbling of saliva. 
Anosmia. 
Depression. 
Aching pain. 
Sleep disorders. 
Cognitive impairment.

Question 5

How is PD usually diagnosed.

Answer 5

Clinically from symptoms.

Question 6

What must be excluded in young (2)

Answer 6

Wilson’s disease.

Mass lesions.

Question 7

What are the cardinal triad features of parkinsonianism. (3)

Answer 7

Tremor - worse at rest, often ‘pill-rolling’.
Rigidity/increased tone - cogwheel rigidity.
Bradykinesia/hypokinesia - slow to initiate movement and slow, low amplitude excursions in repetitive actions.

Question 8

What is the typical age of onset of Parkinson’s disease.

Answer 8

65.

Question 9

What is the prevalence of Parkinson’s disease. (2)

Answer 9

0. 6% at 60-64.

3. 5% at 85-89.

Question 10

What are the red flag symptoms that indicate that it is NOT Parkinson’s disease. (5)

Answer 10

Early postural instability and vertical gaze palsy and falls, rigidity of trunk = progressive supranuclear palsy. 
early autonomic features (impotence/incontinence, postural hypotension) and pyramidal signs = multiple system atrophy. 
Fluctuating cognition with visual hallucinations = lewy body dementia. 
Akinetic rigidity involving one limb, cortical sensory loss, apraxia = cortico-basal degeneration. 
Pyramidal signs (legs) or gait problems = vascular parkinsonianism.