Signs, Symptoms & RFs

• What are the RFs for PD?

  Age (over 70)

  Gender (male)

  Genetics

  Drug use

  Environmental (pesticides/herbicides, pollution)
• Majority of PD cases are sporadic.
• How can genetics increase the risk of PD?

  FH can increase the risk of early-onset PD

  5-10% of Parkinson’s is genetic

  Mutations to;

  • PARK 8 → Autosomal dominant
  • PARK 2 → Autosomal recessive
  • PARK 1/4 → Autosomal dominant → codes for alpha-synuclein
• How can drug use increase the risk of PD?

  Damage to dopamine-containing cells (e.g neurons in substantia nigra)
• What are the motor symptoms of PD?

  Bradykinesia

  Masked face

  Tremor

  Rigidity

  Parkinsonian gait

  Speech changes & swallowing difficulty

  Micrographia (small writing)
• What is the tremor like in PD?

  Resting tremor

  4-6 Hz

  Presenting symptom in 70% of pts

  Starts in fingers/hands (initially unilateral)

  Made worse by emotion or stress
• What speech changes occur in PD?

  Speech becomes quiet, indistinct & flat
• What are the premotor symptoms in PD?

  Anosmia

  Depression/anxiety

  Aches & pain

  REM sleep behaviour disorder

  Autonomic features (urinary urgency, hypotension)

  Constipation

  Restless leg syndrome

  Visual hallucinations & psychosis (late stage)
• PD pts develop non-specific non-motor symptoms during approx 7 years before motor symptoms develop.
• What are some protective factors of PD?

  Smoking

  Alcohol

  Caffeine