Parkinson's Disease

Question 1

Features of Parkinson’s Disease

Answer 1

• bradykinesia - hallmark
• resting tremor
• rigidity
• anosmia
• postural instability (+ falls)
• difficulty initiating movement
• autonomic disorder: constipation, bladder and sexual dysfunction, orthostatic hypotension
• sleep disorders: vivid dreams, restless leg, daytime hypersomnolence
• dementia
• psychosis
• depression
• impulse control disorders

Question 2

1st line treatments for motor PD Sx

Answer 2

• levodopa with dopa decarboxylase inhibitor, as co-beneldopa or co-careldopa (better motor improvement, but may cause more motor complications)

or MAO-B inhibitors e.g. selegiline, rasagiline, safinamide

or dopamine agonists e.g. pamiprexole, ropinirole

Question 3

Adjuvant treatments for motor PD Sx

Answer 3

• COMT inhibitors e.g. entacapone
• amantadine (reduces dyskinesia)
• SC apomorphine (dopamine agonist)
• DBS of subthalamic nucleus