Parkinsons

Question 1

What is Parkinson’s Disease (PD)?

Answer 1

Progressive neurodegenerative condition caused by degeneration of dopaminergic neurones in the substantia nigra (basal ganglia)

Question 2

What is the main neurotransmitter reduced in Parkinson’s Disease?

Answer 2

DOPAMINE

Question 3

What is the male to female ratio in Parkinson’s Disease prevalence?

Answer 3

2:1 (M:F)

Question 4

At what age group is Parkinson’s Disease most commonly diagnosed?

Answer 4

65+

Question 5

What are the classic triad symptoms of Parkinson’s Disease?

Answer 5

• Bradykinesia
• Resting Tremor
• Rigidity
  + Symptoms are usually asymmetrical and worse on 1 side

Question 6

Describe Bradykinesia in Parkinson’s Disease.

Answer 6

Short, shuffling gait with reduced arm swing and difficulty initiating movements

Question 7

What characterizes the tremor in Parkinson’s Disease?

Answer 7

‘Pill-rolling’ tremor that worsens when stressed/tired and at rest, improves with voluntary movement

Question 8

What is meant by rigidity in Parkinson’s Disease?

Answer 8

Lead pipe (hypertonia) or cogwheel rigidity when tremor is superimposed

Question 9

What is Parkinson’s facies?

Answer 9

Expressionless appearance (mask-like)

Question 10

List other common symptoms of Parkinson’s Disease.

Answer 10

• Flexed posture
• Drooping of saliva
• Fatigue
• Psychiatric features: depression, dementia, psychosis, sleep disturbances + REM disorders
• Autonomic dysfunction - Postural hypotension

Question 11

What does Parkinsonism refer to?

Answer 11

A spectrum of neurodegenerative disorders characterized by bradykinesia, rigidity, tremor, and postural instability

Question 12

What is the most common cause of Parkinsonism?

Answer 12

Parkinson’s Disease (PD)

Question 13

What is a notable characteristic of drug-induced Parkinsonism?

Answer 13

Motor symptoms often BILATERAL and RAPID onset; rigidity and rest tremor uncommon

Question 14

How can essential tremor be differentiated from Parkinson’s tremor?

Answer 14

• ‘Pill-rolling’ rest tremor (4-6 Hz)
• 123I-FP-CIT single photon emission computed tomography (SPECT)

Question 15

What blood tests are done to rule out other causes of tremor?

Answer 15

• FBC
• U&Es
• LFTs
• TFTs
• Ca/PTH
• B12/folate

Question 16

What imaging techniques are used in the diagnosis of Parkinson’s Disease?

Answer 16

• MRI
• PET
• DaT scan (for reduced uptake of dopamine)

Question 17

How is Parkinson’s Disease diagnosed?

Answer 17

Clinically diagnosed and managed by a specialist

Question 18

What is the first-line treatment for motor symptoms affecting a patient’s life?

Answer 18

Levodopa (+Carbidopa or Benserazide)

Question 19

What is the treatment for motor symptoms not affecting a patient’s life?

Answer 19

Dopamine agonists or monoamine oxidase B inhibitor (MAO-Bi)

Question 20

What should be added if a patient continues to be symptomatic despite optimal levodopa?

Answer 20

• Dopamine agonists
• MAO-B inhibitors
• COMT inhibitors

Question 21

What medication is used for drooling in Parkinson’s Disease?

Answer 21

Glycopyrronium Bromide

Question 22

What medication is used for orthostatic hypotension in PD?

Answer 22

Midodrine

Question 23

What is Levodopa?

Answer 23

Precursor to dopamine that forms dopamine upon crossing the blood-brain barrier

Question 24

What is prescribed with Levodopa to prevent peripheral metabolism?

Answer 24

Decarboxylase inhibitor (Carbidopa/Benserazide)

Question 25

List some side effects of Levodopa.

Answer 25

* Dry mouth * Anorexia * Palpitations * Postural hypotension * Psychosis * Impulse control disorder

Question 26

What are the adverse effects of stopping dopaminergic drugs?

Answer 26

Risk of acute akinesia or neuroleptic malignant syndrome

Question 27

What characterizes Benign Essential Tremor?

Answer 27

* Symmetrical * Improves at rest and worse with intentional movement * No other PD features * Improves with alcohol