Parkinson's Disease

Question 1

Define:

Answer 1

Neurodegenerative disease of dopaminergic neurones of the substansia nigra

This can be due to mitochondrial DNA dysfunction

Pts are only symptomatic after they have lost 70%

Question 2

Aetiology/risk factor:

Answer 2

Sporadic/ idiopathic is the most common with an unknown aetiology

2ndry causes:
o Neuroleptic therapy (e.g. for schizophrenia)
o Vascular insults (e.g. in the basal ganglia)
o MPTP toxin from illicit drug contamination
o Post-encephalitis
o Repeated head injury
o Manganese or copper toxicity (Wilson’s disease)
o HIV

There are some familial forms of Parkinson’s disease

Question 3

Epidemiology:

Answer 3

Very common
Affects 1-2% of >60 yrs
Mean age of onset = 57

Question 4

Symptoms:

Answer 4

Insidious onset 
Resting tremor especially in the hands
Stiffness and slow movements
Difficulty initiating movements
Frequent falls
Micrographia
Insomnia
Mental slowness
Reduced sense of smell
Depression 
Dribbling saliva 
Visual hallucinations
Constipation 
Urgency/frequency

Question 5

Signs:

Answer 5

Tremor- pill rolling resting tremor

Rigidity - cogwheel rigidity enhanced by distraction

Gait - shuffling, hunched over, small steps, difficulty initiating movements

Postural instability

Hypomimic face

Depression

Cognitive problems and dementia

Frontalis overactivation

Question 6

Investigations:

Answer 6

Usually done by a clinical diagnosis

CT/MRI of the brain - rule out other causes such as hydrocephalus

Levadopa trial - give levadopa then timed walking assessment after the administration

Bloods - serum ceuroplasmin to rule out wilson’s.

Dopamine transporter scintography = reduced in the straitum and putamen