Parkinson's Disease

Question 1

Define Parkinson’s Disease

Answer 1

Neurodegenerative disease due to a severe loss in dopaminergic neurones in the substantia nigra

Question 2

What is Parkinsonism and Parkinsons plus

Answer 2

Parkinsonism = symptoms of Parkinson’s either in other diseases (Lewy body dementia) or as S/E of medication (DA antagonist)

Parkinson plus syndrome = Group of neurodegenerative diseases with Parkinsonism and additional features (not in idiopathic PD)

Question 3

What are the Parkinson’s plus disorders

Answer 3

MSA - multiple system atrophy (Parkinson’s + autonomic systemic changes)

CBD - cortical bulbar degeneration (Parkinson’s + they believe to have an additional moving limb)

PSP - progressive supranucleic palsy (Parkinson’s + supranuclear gait palsy - impaired gaze, balance, dysarthria)

Question 4

Aetiology of Parkinson’s Disease

Answer 4

Idiopathic

Substantia nigra degeneration -> dopamine deficiency -> motor symptoms

Question 5

Risk factors for Parkinson’s Disease

Answer 5

Increasing age
Male sex
Hx diet of familial PD in younger-onset disease
Mutation in gene encoding glucocerebrosidase
MPTP exposure
Chronic exposure to metals (manganese, iron)
Additional genetic risk factors
Head trauma
Toxin exposure e.g. insecticides
Occupation as teacher, healthcare provider, construction worker, carpenter or cleaner

Question 6

Symptoms of Parkinson’s Disease

Answer 6

Cardinal:
Resting tremor 
Rigidity (lead pipe)
Bradykinesia
Postural instability

Others:
Fatigue
Constipation
Depression
Anxiety 
Dementia
Hypophonia (reduced volume)
Micrographia
Stopped posture

Question 7

Signs of Parkinson’s Disease on examination

Answer 7

Cogwheel rigidity 
Shufflin gait (esp. when turning corners)
Reduced arm swing
Pill rolling tremor
Masked face/hypomimic face (look at blinking)
Hypophonia (reduced volume)
Hypokinetic dysarthria 
Micrographia
Stopped posture
Conjugated gaze disorder

Question 8

What are the signs of Parkinson’s dementia

Answer 8

Amnestic, language deficit 
Visuospatial dysfunction i.e. clockface numbers are not in the right place
Hallucinations
Fluctuations
Aggression/anxiety

Question 9

Investigations for Parkinson’s Disease

Answer 9

Clinical diagnosis

Dopaminergic agent trial: improvement in symptoms

Urine copper + caeruloplasmin: exclude Wilson’s

MRI brain: normal in most, advanced -> cortical atrophy, dorsolateral nigra hyperintensity
FP-CIT or PET: reduced basal ganglia pre-synaptic dopamine uptake