Parkinsons

Question 1

Define Parkinson’s disease

Answer 1

neurodegenerative condition caused by degeneration of dopaminergic neurons in the substantia nigra

Question 2

Classical triad of features

Answer 2

bradykinesia
tremor
rigidity

**classically symptoms re asymmetrical

Question 3

Usual demographic

Answer 3

Men
average age 65

Question 4

Describe how a patient may present with bradykinesia

Answer 4

• hypokinesia
• short, shuffling steps with
• reduced arm swinging
• difficulty in initiating movement

Question 5

Describe the typical tremor seen in Parkinsons

Answer 5

• present at rest
• 3-5 Hz
• worse when stressed or tired,
• typically ‘pill-rolling’

Question 6

Other characteristic features

Answer 6

mask-like face
flexed posture
micrographia
drooling of saliva
impaired olfaction
REM sleep behaviour disorder
fatigue
postural hypotension

Question 7

Drug induced parkinsonism

Answer 7

motor symptoms are generally rapid onset and bilateral

rigidity and rest tremor are uncommon

Question 8

Management

Answer 8

Motor symptoms affecting QoL => levodopa
If not:
=> dopamine agonist, levodopa or MAO‑B inhibitor

**can combine 2 agents if symptoms continue on one

Question 9

Causes of ParkinsonISM

Answer 9

• PD
• drugs (antipsychotics, metoclopramide)
• Progressive supranuclear palsy
• Multiple system atrophy
• Wilson’s disease
• post-encephalitis
• Toxins: carbon monoxide