Parkinson's Disease Overview and Diagnosis Flashcards
Symptoms of Parkinson’s disease that occur years to decades before motor symptoms
Constipation Loss of olfaction REM sleep behaviour disorder Depression/anxiety Fatigue Restless legs syndrome Subtle cognitive deficits
Lewy body
Alpha synuclein protein that gets walled away
May start in the gut and travel up vagus nerve to CNS
Early motor features of PD
Stiffness of one shoulder Reduced arm swing Dragging of one leg/difficulties turning Intermittent resting tremor in one hand Micrographia Reduced facial expression/blinking Stooped posture Difficulties playing a musical instrument
Dykinesias
Due to progression of underlying PD plus dopaminergic therapy
Spectrum of chorea to dystonia
Occurs after about 3-5 years of treatment (more frequent in younger patients)
Can be disabling
Can occur with high and low DA levels
What is the leading cause of death in PD
Pneumonia
Constipation in PD
Potential complications: megacolon, obstruction
Reduced absorption of levadopa
Treat!
Psychosis in PD
Illusions Hallucinations (mostly visual) Delusions Associated with cognitive impairment Exacerbation with medical illness
Features of PD
Need bradykinesia (slowness of initiation, progressive reduction in speed/amplitude with repetitive action)
And one of: rigidity, rest tremor
Postural instability is a feature of parkinsonism, but not PD
Red flag features that suggest not PD
Symmetrical symptoms Early falls or freezing gait Severe dysautonomia in first 5 years of disease Early dementia Exposure to DA blocking medications Inspiratory stridor Otherwise unexplained pyramydal symptoms Cerebellar dysfunction
2 symptoms most predictive of PD
Asymmetric onset of tremor/rigidity/bradykinesia
L-dopa responsiveness (persistent, with dyskinesias)
Multiple System Atrophy
Hallmark feature is early, severe dysautonomia (orthostatic hypotension, urinary urge incontinence, ED)
Patients have either Parkinsonism unresponsive to L-DOPA, or ataxia
Red flags suggesting MSA: anterocollis, symmetrical symptoms, stridor, unexplained UMN features, early falls
Hot cross bun sign on imaging (atrophic pons)
Progressive supranuclear palsy
Axial rigidity, early falls, supranuclear vertical gaze palsy (cannot look down), pseudobulbar palsy, dementia/frontal lobe deficits/personality changes (mild)
“Surprised lool”, deepening of facial creases
Extended trunk, retrocollis
Hummingbird sign on imaging (atrophic midbrain)
Dementia with Lewy bodies
Dementia
Fluctuating cognitive impairment, attention, alertness
Visual hallucinations
Parkinsonism
REM-sleep behavioural disorder
Severe neuroleptic sensitivity
May be on a spectrum with PD (here the cognitive stuff happens before the motor)
Corticobasal degeneration
Overlap with PSP Asymmetric rigidity, bradykinesia, dystonia Often affecting mainly 1 limb Striatal hand, alien hand Myoclonus, apraxia Asymmetrical atrophy on imaging
