Parkinson's

• What is Parkinson's?


  Degeneration of dopaminergic neurons
• What are the 4 diagnostic symptoms of Parkinson's?

  Bradykinesia

  Rigidity

  Postural instability

  Resting tremor
• What are some symptoms in Parkinson's?

  Micrographia

  Hypomimia

  Shuffling gait

  Freezing

  Reduced arm swing

  Quiet/slow speech
• What are some risk factors for Parkinson's?


  Male

  Age (older)

  FHx
• What are some bedside investigations for Parkinson's?


  HIstory

  Neuro exam

  Check micrographia
• What are some blood tests for Parkinson's?


  Confusion screen / other exlusionary
• What scans can be done for Parkinson's?

  DaT scan
• What do you expect to see in a DaT scan for someone with Parkinson's?


  Loss of commas
• What is asked in a Parkinson's history?

  DHx (drug induced)

  SHx (alcohol withdrawal)

  FHx

  PMHx

  Sleep
• How is Parkinson's managed conservatively?


  Physio and OTs

  SLT

  Parkinson's specialist nurse
• What are some surgical interventions for Parkinson's?


  Deep brain stimulation (severe symptoms)
• How is Parkinson's managed pharmacologically?


  Co-careldopa

  MAO inhibitors (monoamine oxidase)

  Dopamine agonists
• What is a protective factor in Parkinson's?

  Smoking
• What causes Parkinson's disease?

  Loss of dopaminergic neurons in the substantial nigra -> dopamine depletion in the striatum -> imbalance between dopamine and acetylcholine = improper muscle movement
• How does lead pipe rigidity differ from cog wheel rigidity?


  Lead pipe: Constant, mostly in lower limb

  Cog wheel: Varies, mostly in upper limb
• How is Parkinson's disease diagnosed (using NICE criteria)?


  Gradual onset of:

  • Bradykinesia
  • Hypokinesia

  PLUS one of:

  • Stiffness
  • Resting tremor
  • Balance problems
• What are some ddx for a tremor?


  Benign essential tremor

  Hyperthyroidism

  Caffeine/alcohol
• What are some other ddx for someone presenting with Parkinsons?


  Vascular parkinsonism

  Parkinson-plus syndromes
• What are some examples of Parkinson-plus syndromes?


  Multi-system atrophy

  Progressive supranuclear palsy

  Corticobulbar degeneration

  Lewy body dementia
• Fill in this table regarding Parkinson's tremor

  A) Asymmetrical

  B) 4-6

  C) Worse at rest

  D) Improves

  E) Parkinson's

  F) alcohol

  
• Fill in this table regarding benign essential tremor

  A) Symmetrical

  B) 6-12

  C) Improves

  D) Worse

  E) Parkinson's

  F) Alcohol