Parkinson's Disease

• What is Parkinson's disease?

  Neurodegenerative disorder

  Progressive reduction in dopamine in the basal ganglia -> disorders of movement
• What is the classic triad of Parkinson's disease?

  Resting tremor

  Rigidity

  Bradykinesia
• Fill in the blanks

  A) facial masking

  B) stooped posture

  C) forward tilt

  D) reduced arm swing

  E) shuffling gait

  
• What is the difference between Parkinsonism & Parkinson's disease?

  Parkinsonism = general term referring to a group of neurological disorders that cause movement problems

  Parkinson's disease = neurodegenerative brain disorder, idiopathic parkinsonism
• Pathophys - Parkinson's

  Alpha-synuclein aggregates & tangles → creation of Lewy body inclusions → neuronal cell death (esp. dopaminergic neurons in substantia nigra pars compacta) → decrease in dopamine & increase in ACh → less dopamine released at striatum via nigrostriatal pathways → less direct pathway & more indirect pathway → degeneration spreads as the condition progresses → spreads from lower brainstem to midbrain, then to cortex

  When someone loses around 80% of dopaminergic neurons → motor symptoms appear
• What are the RFs for Parkinson's disease?

  FHx

  Previous head injury

  Age (over 70)

  Male
• What are the protective factors for Parkinson's disease?

  Smoking

  Caffeine

  Physical activity (esp. aerobic exercise)
• What are the signs & symptoms of Parkinson's disease?

  Resting tremor (pill-rolling)

  Muscle rigidity

  Bradykinesia (slowness of movement & delay in initiation)

  Postural instability

  Mask-like face

  Hypokinetic dysarthria & speech impairment

  Micrographia

  Dysphagia

  Mood disturbance (depression, apathy, anxiety)

  Psychotic episodes

  Visual hallucinations

  Paranoid delusions

  Sleep dysfunction

  Constipation
• What are the DDx of Parkinson's disease?

  Essential tremor

  Multiple system atrophy

  Lewy body dementia

  Drug-induced parkinsonism

  Vascular parkinsonism
• What are the Inx for Parkinson's disease?

  Full Hx & examination

  Primarily clinical diagnosis

  MRI

  DaT (dopamine transporter) scan
• What is the management of Parkinson's disease?

  Meds

  • levodopa
  • monoamine oxidase B (MAO-B) inhibitors
  • dopamine agonists
  • COMT inhibitors

  Deep brain stimulation (if not adequately controlled by meds)

  Physio

  SALT

  OT
• What is the main side effect of levodopa?

  Dyskinesia
• How can dyskinesia associated with levodopa be managed?

  Amantadine (glutamate antagonist)
• What are the possible complications of Parkinson's disease?

  Autonomic dysfunction

  Recurrent falls

  Cognitive impairment