Parkinson's Disease

Question 1

mean age of onset?

Answer 1

Mean age of onset is 60 years.

Question 2

what is it?

Answer 2

Loss of dopaminergic neurons in the substantia nigra.

Question 3

Extrapyramidal triad of:

Answer 3

1. Tremor – ‘pill-rolling’, worse at rest.
2. Rigidity (hypertonia) – rigidity+ tremor gives cogwheel rigidity.
3. Bradykinesia – slow to initiate movement, shuffling gait, expressionless face.

Question 4

are signs worse on one side?

Answer 4

YES

if symmetrical - look for other causes

Question 5

Want to exclude cerebellar disease and fronto-temporal dementia on examination by looking for core features of PD like?

Answer 5

: bradykinesia with resting tremor +/- hypertonia

Question 6

Tx:

Conservative Management

Parkinson’s disease patients should be offered:

Answer 6

• physiotherapy
• speech and language therapy
• occupational therapy
• dietitian

Question 7

Tx of PD:

In early stages of Parkinson’s disease, patients whose motor symptoms decrease their quality of life should be offered

Answer 7

levodopa combined with:

carbidopa (co-careldopa) OR benserazide (co-beneldopa)

Question 8

Tx of PD:

Parkinson’s disease patients whose motor symptoms do not affect their quality of life, could be prescribed a choice of:

Answer 8

levodopa (dopamine precursor) OR
dopamine receptor agonists (pramipexole/ropinirole)
OR
MAO-B inhibitors (rasagiline)

Question 9

• If tremor is insufficiently treated by above medication can give?

Answer 9

Propanolol

Question 10

People with suspected Parkinson’s disease should be referred urgently, and untreated, to a specialist in movement disorders for confirmation of the diagnosis and exclusion of alternative conditions

Can put patient on a what trial if questioning diagnosis?

Answer 10

Dopaminergic agent trial