Parkinson's disease

Question 1

Define Parkinson’s

Answer 1

A hypokinetic neurodegenerative movement disorder characterised by parkinsonism and neuronal loss/lewy bodies in the substantia nigra (loss of dopamine secreting cells)

Question 2

Pathology of Parkinson’s

Answer 2

1. Progressive loss of dopamine secreting cells due to Lewy body formation
2. Decrease output from cortex to basal ganglia (regulates movement)

Question 3

3 main clinical features of Parkinson’s + other

Answer 3

1. Bradykinesia - slow initiation of movement with decreasing amplitude on repetition. Shuffling, pitched forward gait, smaller writing
2. Tremor - at rest, ‘pill-rolling’ movement of thumb over finger
3. Rigidity/hypertonia - stiffness, increased tone, pain, ‘cogwheel rigidity’
4. Characteristic stoop

Question 4

Diagnosis of Parkinson’s

Answer 4

1. Clinical diagnosis
2. Response to dopaminergic therapy supportive
3. MRI/CT - substantia nigra damage

Question 5

Management of Parkinson’s

Answer 5

Step 1: L-DOPA and peripheral DOPA decarboxylase inhibitor (levodopa + carbidopa)
Step 2: Dopamine agonists (ropinirole)
MAO-B inhibitors: selegiline, rasagiline
Anticholinergics treat tremor - amantadine

Question 6

Complications of Parkinson’s

Answer 6

1. Depression, phobia, anxiety disorder
2. Dementia
3. Autonomic issues (increased urinary frequency, constipation)