Parkinson's disease

Question 1

Parkinson’s cardinal features

Answer 1

Neurodegenerative progression of disease.

• Bradykinesia (Slow)
• Rigidity (Stiff)
• Resting tremors (Shaky)
• Loss of postural stability

Question 2

Pathophysiology

Answer 2

Degeneration of dopaminergic neurones in the substantial nigra (Brainstem)

• Lack of DA input into the basal ganglia
• Inhibits direct pathway of movement (bradkinesia, stiffness)
• Disinhibition indirect pathway of movement (resting tremor)

Presence of Lewy bodies in neurones

• Alpha synclein
• Ubiquitin

Question 3

Risk factors for PD

Answer 3

Age
- Older (over 50?)

Family history

Exposure to MPTP

Question 4

HPC

Answer 4

Onset of symptoms

• Is it progressively getting worse
• Is it constant, varied

How range of movement is affected

• Is mobility affected
• Not being able to do certain activities the same again
• Limbs that are affected

Is mood affected (depression)

Changes in posture or hair

Tremor

• When exactly does it start (at rest, intentional)
• What character of tremor (fine, coarse, trembling)

Speech affected
- Slower, slurred, hypotonia

Changes in smell

Sleeping problems (REM behaviours)

Writing affected?
- micrograph

Collateral

• Changes in mood
• Changes in facial expression

Question 5

PMH

Answer 5

Current neurological disease

History of CVA

Head trauma history

Exclude psychosis

Dementia

Hyperthyroidism
- Rule out cause of tremor

Question 6

SH

Answer 6

Alcohol, smoking, drugs
- rule out withdrawal as cause of tremor

Occupation/ Sports

• Exposure to MPTP
• Head trauma sports injury

Question 7

DH

Answer 7

Anti-psychotics (first generation, less severe is second generation)

• Rule out Parkinsonism

Antiemetics

• Can cause Parkinsonism
• metoclopramide
• Prochlorperazine