Parkinsons

Question 1

What causes Parkinson’s?

Answer 1

Loss of dopaminergic neurons within the substantial nigra.

Question 2

How does the incidence of Parkinson’s change as people age?

Answer 2

Incidence increases with age and cases are increasing due to an ageing population

Question 3

Symptoms of Parkinson’s?

Answer 3

Bradykinesia or akinesia - slowness of movements, problems doing up buttons, writing smaller, reduced arm swing, dragging one foot while walking

Resting tremor - may be unilateral

Rigidity - pain and problems turning in bed

Question 4

Signs found one examination in a patient with Parkinson’s

Answer 4

• Small stepped gait
  
  • Stooped posture and reduced arm swing L > R
• Increased tone = rigidity
  
  • Tone increased over entire radius of joint movement
• Rest tremor
  
  • Often asymmetrical, also some postural tremor
  • Tremor tends to be slower than those with essential tremor
• Decreased amplitude/accuracy of repetitive movements
  
  • Much better at the beginning and gradually worsens
  • Ask the patient to repetitively open and close hand (beak shape) = decrease in rhythm and amplitude of the movement
  • Compare left vs right

Question 5

Pathology of PD.

Answer 5

Loss of dopamine neurone in the substantial nigra

Question 6

What do we use to differentiate PD from ET?

Answer 6

Visualise reduced dopamine supply to stratium using DaTSCAN

Question 7

What causes the loss of dopamine in substantial nigra in Parkinson’s?

Answer 7

Combination between susceptibility and environmental factors leading to cell loss.

• Inherited factors: parkinson genes, susceptibility factors
• Mitochondrial dysfunction
• Oxidative stress
• Environmental factors: risk factors and toxin induced.

Question 8

Treatment for Parkinson’s?

Answer 8

No cure
1. L-dopa = most powerful and usually used starting with low dose. 3 different preparations (standard, dispersable and slow release)

2. Dopamine agonists - first line for younger patients <60.
3. Catechol-o-methy-transferase inhibitors and MAO inhibitors - not as powerful, might have neuroprotective effects.

Question 9

Complications of PD?

Answer 9

• Depression - very common (20-40%)
• Other psychatric disorders - phobias, anxiety dementia, hallucinations
• Dementia (20%) - particularly old, severely affected patients
• Autonomic problems - constipation (affects absorbtion of medication and is easily treated so we need to pick up on this), increased urinary frequency (urinary incontinence is not typical)

Question 10

What is essential tremor?
Features of ET?
Treatment for ET?

Answer 10

Neurological condition causing hands (commonly) to shake rhythmically.

• Tremor is present on action not noticeable when at rest
• Better after alcohol, worse with caffeine or stress.
• Gradual worsening as the patients age
• Genetic link (50% chance of child having if parent has it)

Treatment

• Beta blockers - CI in asthma, COPD or diabetes
• Primidone - anti-epileptics, start with low doses