Parkinson's Disease

Question 1

Define Parkinson’s Disease?

Answer 1

Neurodegenerative disease of the dopaminergic neurones of the substantia nigra

Question 2

What is Parkinson’s Disease characterised by?

Answer 2

Bradykinesia
Rigidity
Resting tremor
Postural instability

Question 3

What is the pathophysiology of Parkinson’s Disease?

Answer 3

Degeneration of dopaminergic neurones projecting from the substantia nigra to the striatum
Patients are only symptomatic after the loss of > 70% of dopaminergic neurones

Question 4

What are the characteristics of Sporadic/Idiopathic Parkinson’s Disease?

Answer 4

Most COMMOn
Aetiology UNKNOWN
May be related to environmental toxins and oxidative stress

Question 5

What is the aetiology of Secondary Parkinson’s Disease?

Answer 5

Neuroleptic therapy (e.g. for schizophrenia)
Vascular insults (e.g. in the basal ganglia)
MPTP toxin from illicit drug contamination
Post-encephalitis
Repeated head injury

Question 6

What is the genetic component of Parkinson’s Disease?

Answer 6

There are some familial forms of Parkinson’s Disease

Question 7

What is the epidemiology of Parkinson’s Disease?

Answer 7

Very COMMON
Prevalence: 1-2% of > 60 yrs
Mean age of onset: 57 yrs

Question 8

What are the presenting symptoms of Parkinson’s Disease?

Answer 8

INSIDIOUS onset 
Resting tremor (mainly in hands)
Stiffness and slowness of movements 
Difficulty initiating movements 
Frequent falls 
Smaller hand writing (micrographia)
Insomnia 
Mental slowness (bradyphenia)

Question 9

What are the characteristics of the tremor of Parkinson’s Disease?

Answer 9

Pill rolling rest tremor
4-6 Hz
Decreased on action
Usually asymmetrical

Question 10

What are the characteristcs of the Rigidity for Parkinson’s Disease?

Answer 10

Lead pipe rigidity of muscle tone
Superimposed tremor can cause cogwheel rigidity
Rigidity can be enhanced by distraction

Question 11

What are the characteristics of Gait for Parkinson’s Disease?

Answer 11

Stooped 
Shuffling 
Small-stepped gait 
Reduced arm swing 
Difficulty initiating walking

Question 12

What happens with the Postural Instability for Parkinson’s Disease?

Answer 12

Falls easily with little pressure from the back or the front

Question 13

What are the other features of Parkinson’s Disease?

Answer 13

Frontalis overactivation (leads to furrowing of the brow)
Hypomimic face 
Soft monotonous voice 
Impaired olfaction
Tendency to drool
Mild impairment of up-gaze

Question 14

What are the psychiatric features of Parkinson’s Disease?

Answer 14

Depression

Cognitive problems and dementia (in later stages)

Question 15

What investigations do you do for Parkinson’s Disease?

Answer 15

Levodopa Trial
Bloods
CT or MRI Brain
Dopamine Transporter Scintigraphy

Question 16

Why do we do a Levodopa Trial for Parkinson’s Disease?

Answer 16

Timed walking and clinical assessment after administration of levodopa

Question 17

What bloods do you do for Parkinson’s Disease?

Answer 17

Serum caeruloplasmin - rule out Wilson’s disease as a cause of Parkinson’s Disease

Question 18

Why do we do CT or MRI brain for Parkinson’s Disease?

Answer 18

To exclude other causes of gait decline (e.g. hydrocephalus)

Question 19

What do we see on a Dopamine Transporter Scintigraphy for Parkinson’s Disease?

Answer 19

Reduction in striatum and putamen