Parkinsons Disease

Question 1

Defintion of Parkinsons

Answer 1

progressive disease of neuronal degenerationin the substantia niagra that usually presents in the elderly

Question 2

Epidiemiology

Answer 2

onset between 45-60

Question 3

Aetiology

Answer 3

2/3 idiopathic parkinsons

Other causes
V- vascular events (stroke, MI)
O- orthostatic hypotension with atonic bladder (multi-system atrophy)
D- dementia
K- Kayser-fleisher rings - Wilsons disease
A-apraxic gait - communitcating hydrocephalis

Question 4

Pathophysiology of Parkinsons disease

Answer 4

1. loss of dopaminergic neurons in the substantia niagra pars compacta of the basal ganglia (synthesize dopamine production, acts as an inhibtory neurotransmitter at projection sites the corpus stratum)
2. decreased dopamine production
3. compensatory response (upregulation of dopamine receptors, increase dopamine prodction)
4. compensatory fail
5. decreased activation of direct pathway( decreased movement initiation)
   a. Brady kinsesia (slow movements)
   b. hypokinesia (decreased movements)
6. initiation of indirect pathway (increased movement inhibition)
   a. postural instability,
   b. impaired regulation of muscle tone (hypertonia)

Question 5

Clinical features of parkinsons (motor symptoms)

Answer 5

1. Bradykinesia/hypokinesia- slow to initiate movements (picking up pens)
2. tremor - resting pin rolling tremor
3. Ridgity/ tone- Rigidity + tremor - cogwheel rdgiity

Posture and gait:
- shuffling gait, reduced arm swing

Speech

• normal tone is lost, becomes monotonous
• plain face stare (reduced blinking rate)
• GI problems (heartburn, dysphagia)
• D

Question 6

Clinical features of parkinsons (non-motor)

Answer 6

1. neuropsychiatric - dementia (lewy bodies) , depression
2. . sleep- REM (rapid ee movement sleep dsitrubance)
3. Autonomic: constipation, urgency, erectile dysfuncition, dribbling

Question 7

Investigations of parkinsons

Answer 7

1. Bloods
   - tremor symptoms check TFTs
2. Structural imaging CT/MRI normal in PD
3. Functional imaging
   - DAT spec - usess dopamine transporter which is uptake in the presynaptic junction for dopamine function

Question 8

Disease progression

Answer 8

1. prdorome (early symtpoms before specific symptoms )
   - -> 20 ears
   - bladder disorder/ constipation and then sleep disorder
2. clinical onset - 20 years

Question 9

Braak stages

Answer 9

describes the rostral spread

stage 1-2 = medulla/pons and olfactory nucleus- presymptomatic/pre motor
stage 3-4 = midbrain (SN pars compacta) - 50% of damage
stage 5-6 = neurocortex involvement - dementia

Question 10

Hoen and Yahr scale of disease progression

Answer 10

Symptoms on oneside (unilaterall)
bilateral
loss of balance
falls, dependancy, and cognitive disease

Question 11

Multidisciplinary team involvement

Answer 11

GP&
• Neurologist/care of the elderly and physician
• Parkinson’s disease nurse specialist
• Physiotherapist
• Speech and language therapist
• Psychiatrist
• Psychologist
• Occupational therapist
• (Palliative care team)
• (Neurosurgeon)

Question 12

Drug treatment of parkinsosnn

Answer 12

first line 
-dopamine precursor - Ldopa 
Second line 
-dopamine agonist - Ropinirole 
-mono-oxidase-B inhibitor = selgeiline 
-anti-cholinergics = amatadine 
-catechol-o-methyl transferase

Question 13

What is the extraoyrimidal system

Answer 13

general term for the basal ganglia and their connections with other brain areas, particularly those concerned with movement. The overall function is the initiation and modulation of movement.

Extrapyrimidal or movement disorders are:

• Akinetic-rigid syndromes- ie slowed movement with increased muscle tone
• dskyinsias- added incontrollable movements

Question 14

Akinetic rigid syndromes

Answer 14

• Idiopathic parkinsons
  -Drug induced parkinsonism
  Wilsons diseazse

Question 15

Dyskinesis

Answer 15

Essential tremor
Huntingtons
Dystonias