Parkinson's diseease

Question 1

Prevalence

Answer 1

1% of people older than 65
mean age of diagnosis is 70
M:F = 3:2

insidious and asymptomatic onset

Question 2

Cardinal triad of PD

Answer 2

1. Tremor
   - worse at rest
2. Rigidity
3. Bradykinesia
   * 4. postural instability

Question 3

PD’s findings on neuro exam

Answer 3

• expressionless face
• monotonous speech, low volume
• weak upward gaze
• asymmetrical cogwheel rigidity
  (exaggerated stretch reflex is interrupted by tremor)
• bradykinesia (twiddling test)

Question 4

Investigation for PD

Answer 4

diagnosis of exclusion

bloods - exclude thyroid and liver damage

brain CT - exclude stroke or tumour

PET scan - can detect low level or dopaminergic activity but not practical due to cost

Question 5

Treatment

Answer 5

1. Levodopa
   - mainstay of PD treatment
   - administer with carbidopa (decarboxylase inhibitor to prevent peripheral conversion to dopamine)
   - effective for tremor, bradykinesia, rigidity
   - not effective for postural stability

SE

1. N/V
2. postural hypotension
3. abdo cramp, diarrhoea
4. delusion, hallucination, agitation, psychosis
5. somnolence, dizziness,headache
6. COMT inhibitor
   - in adjunct with levodopa (prevent breakdown of l-dopa

Question 6

Non-motor signs of PD

Answer 6

1. anosmia
2. postural hypotension
3. depression
4. constipation
5. urinary incontinence/urgency
6. REM sleep disorder
7. fatigue

Question 7

Multidisciplinary team

Answer 7

1. PT
2. OT
3. speech pathologist
4. psychologist
5. social worker
6. dietician
7. GEM/rehab

Question 8

Rehab criteria

Answer 8

1. want to participate
   - consented, motivated
2. can participate, can learn
   - cognitive intact
   - medically stable, psychologically stable
   - can tolerate 3 hr/day of treatment
3. has goal
   - functional gain in set time-frame