Parkinson's Workshop

Question 1

What is Parkinson’s disease?

Answer 1

• Progressive disease of the neurological system resulting from the degeneration of dopamine producing neurons in the substantia nigra.
• Clinical signs are evident when approximately 80% of dopamine producing neurons have been lost.
• Dopamine is a major neurochemical messenger that promotes function of the basal ganglia: to orchestrate the performance of well learnt, voluntary and semi-automatic motor skills and movement sequences.
• Dopamine also contributes to cognitive processes: maintaining/switching focus of attention, motivation, mood, problem solving, decision making and visual perception.

Question 2

Incidence of PD (not that important)

Answer 2

• In the UK, around 145,000 people are already living with Parkinson’s. Every hour, two more people are diagnosed. That’s the same as 18,000 people every year. 1 in 37 people alive today will be diagnosed with Parkinson’s in their lifetime. (Parkinson’s UK 2020)
• Generally symptoms appear > 50 years of age
• More common in men than women. Men aged 50 to 89 are 1.4 times more likely to be diagnosed with Parkinson’s than women.
• Number of men in the UK, aged 50 to 89, with Parkinson’s: 78,326
• Number of women in the UK, aged 50 to 89, with Parkinson’s: 56,990—
• 1 in 20 < 40 years of age (approximately 9,500)
• Across Sunderland we have over 1600 patients with confirmed Pd
• Across South Tyneside we have over 500 patient with confirmed Pd————

Question 3

What are PD symptoms? (motor)

Answer 3

Motor symptoms:

• Bradykinesia:- refers to the decreased velocity with which a movement is performed
• Rigidity:- also called increased muscle tone, means stiffness or inflexibility of the muscles. (Hohler A.D., Leon M.P. 2011)
• Tremor:- (7/10 patients)
• Festinated gait:- A quickening and shortening of normal strides characterise festinating gait. While the steps are quicker, the stride is shorter, causing this to be a very inefficient gait, which can be frustrating and tiring for the person experiencing it. (Downward 2017)
• Shuffling gait:- appears as if the person is dragging their feet as they walk. Steps may also be shorter in stride (length of the step) in a shuffling gait. The shuffling gait is also seen with the reduced arm movement during walking. (Downward 2017)
• Hypomimia:-also known as ‘facial masking’ – refers to a loss or reduction of facial expressions. (EPDA 2020)
• Micrographia:- abnormally small handwriting or handwriting that becomes progressively smaller that is characteristic especially of Parkinson’s disease. (Parkinson’s Foundation 2021)——

Question 4

What are the stages of PD?

Answer 4

• Diagnostic stage
• Maintenance stage
• Complex stage
• Palliative stage—

Question 5

Explain DaTScan in normal vs PD

Answer 5

No commas in PD

Question 6

What are PD non-motor symptoms?

Answer 6

Non motor symptoms:

• Orthostatic hypotension
• Depression/mood fluctuations/anxiety (4/10 patients)
• REM sleep disorder
• Daytime sleepiness
• Constipation
• Sexual dysfunction
• Bladder dysfunction
• Sweating
• Pain/cramps
• Hypersalivation/swallowing difficulties/speech changes
• Cognitive decline (potentially 8/10 patients)—

Question 7

What are the potential side-effects of PD medication?

Answer 7

• Orthostatic hypotension
• Lethargy
• Nausea/upset stomach
• Diarrhoea
• Dyskinesia - wriggly movement
• Behavioural changes –ICD’s
• Confusion
• Hallucinations
• Somnolence

Question 8

Explain cognitive impairment in PD patients

Answer 8

• Mild Cognitive Impairment
• Parkinson’s Disease Dementia
• Lewy Body Dementia
• Vascular
• ? Onset (medications ICD’s/infection/anxiety)
• Treatment

Question 9

What are the drugs used in Parkinson’s disease?

Answer 9

• Levodopa
  
  • E.g. Co-careldopa capsules or tablet formulation
• Monoamine-oxidase-B-inhibitors
• Catechol-O-methyltransferase inhibitors (extends the (half-)life of levodopa)
  
  • Always to be taken with levodopa
• Dopamine agonists
  
  • E.g. transdermal patch

Question 10

What are some advanced therapies

Answer 10

• Deep brain stimulation
• Apomorphine hydrochloride (PEN)
• Duodopa pump kit

Question 11

How can you support PD patients in hospital?

Answer 11

• Ensure PD medications are given on time
  
  • If given late or omitted possible side-effects:
    
    • Reduced mobility
    • Swallowing difficulties
    • Communication difficulties
    • NMS
• Patients PD symptoms can change from hour to hour
• Patients with PD will have individual PD symptoms
• Medication regimes will differ from patient to patient