Parkinsons Disease

Question 1

def

Answer 1

neurodegenerative disease of the dopaminergic neurones in the substantia nigra

characterised by
1 tremor
2 rigidity or increased tone
3 bradykinesia

Question 2

what is the parkinsons triad

Answer 2

1 tremor
2 rigidity or increased tone
3 bradykinesia

Question 3

what are features of a parkinsonian tremor

Answer 3

worse at rest

‘pill-rolling’ tremor of thumb over fingers

Question 4

what are features of parkinsonian rigidity or increased tone

Answer 4

‘cogwheel rigidity’ felt by examiner on rapid pronation/supination

Question 5

what are features of parkinsonian bradykinesia

Answer 5

slow to initiate movements
reduced blinking rate
monotonous quiet speech
micrographia
expressionless face (hypomimesis)

Question 6

what are causes of parkinsons

Answer 6

1 primary (sporadic + idiopathic) is most common however cause unknown
2 secondary
-drugs such as neuroleptics, metoclopramide
-strokes
-encephalopathy post flu
-repetitive head trauma (boxing)
3 familial forms

Question 7

epi

Answer 7

common

increases with age

Question 8

history

Answer 8

insidious onset:

bradykinesia and one or more of:
1 tremor at rest (worse on one side)
2 postural instability AND/OR
3 rigidity or increased tone

patients may also report difficulty initiating movements, frequent falls, smaller hand writing

Question 9

what are non motor features of parkinsons disease

Answer 9

reduced sense of smell
visual disturbances
dribbling

Question 10

what are risk factors for parkinsons disease

Answer 10

increasing age

family history

Question 11

what sort of gait would be expected in parkinsons disease

Answer 11

shuffling gait with stooped posture

Question 12

pathology

Answer 12

degeneration of midbrain dopaminergic neurones progecting from the substantia nigra pars compacta to the striatum *(caudate nucleus + putamen)
this causes a decrease in striatal dopamine levels

Question 13

what % of neuronal loss is required for symptomatic parkinsons disease

Answer 13

> 70%

Question 14

examination (main features)

Answer 14

1 tremor
-'pill-rolling' rest tremor
-decreased on action
-often asymmetrical
2 rigidity
-lead pipe rigidity of muscle tone
-cogwheel rigidity
3 gait
-stooped, shuffling, small-stepped gait with reduced arm swing
-difficulty initiated walking
4 postural instability

Question 15

examination of other features

Answer 15

expressionless face (hypomimia)
soft monotonous voice (hypophonia)
reduced sence of smell
dribbling

depression is very common
cognitive problems and dementia may occur in late disease

Question 16

investigations

Answer 16

diagnosis is made on clinical history + examination