Parkinson-Plus Syndromes

Question 1

What do we mean by this?

THE FOLLOWING CONDITIONS ARE DIFFERENTIALS FOR PD!!!

Answer 1

Conditions featuring parkinsonism plus additional distinctive features/

Question 2

Progressive supranuclear palsy:

They have the typical signs of PD + any dementia

(1) What is 1 key PD symptom that is quite pronounced in PSP?

(2) What eye symptom is a key symptom of PSP?
- What other eye symptom is present in PD? - 2

(3) Frontal lobe abnormalities - what are 2 key signs?

(4) They also get the following due to a pseudobulbar palsy:
- Dysphagia
- Dysarthria
- Dysphonia

Define all of them?

PSP is also symmetrical in onset whereas PD can be worse on one side.

A tremor is uncommon

Answer 2

Postural instability - they present with falls

Vertical gaze palsy - can’t look down - complete external ophthalmoparesis

Reduced/absent blinking
Eyelid closure

Apathy
Disinhibition
Impaired reasoning as well

Dysphagia
Dysarthria - difficult or unclear articulation of speech
Dysphonia - difficulty speaking due to physical disorder of mouth, tongue and lips

Question 3

Multiple system atrophy:

The 2 distinct features that MSA presents with are:

• Cerebellar features
• Autonomic features**

Give an examples for each?

Diagnosis:

Primarily based on clinical features (especially autonomic dysfunction, including urogenital symptoms)

Answer 3

Cerebellar features - ataxia, tremor, dysarthria
Autonomic features - postural hypotension, urinary incontinence, erectile dysfunction *******

THESE SYMPTOMS TEND TO PRESENT FIRST.

Question 4

Cortico-basal degeneration:

They get dementia at any stage!

• What is the main symptom they suffer from?
• How many limbs are affected?
• What is another major clue it could be this - what would the patient complain of?

Answer 4

Akinetic rigidity + sensory loss

1 limb

Alien limb sensation/phenomenon

Question 5

Dementia with LB:

What are the 3 main symptoms?

What are some other features?

They also get:

• Frequent falls
• Rapid eye movement sleep behaviour disorder - what is it?

They also have increased sensitivity to neuroleptic meds. What type of meds are these.

Answer 5

1. Dementia
2. Extrapyramidal motor symptoms - These symptoms include dystonia (continuous spasms and muscle contractions), akathisia (may manifest as motor restlessness), parkinsonism (characteristic symptoms such as rigidity), bradykinesia (slowness of movement), tremor, and tardive dyskinesia (irregular, jerky movements).
3. VIsual hallucinations

Antipsychotics

Patients with Lewy-body dementia have an increased risk of life-threatening akinetic crises under antipsychotic Rx!

Question 6

Common characteristics of Parkinson-plus syndromes:

What are some features that would steer you away from PD?

Answer 6

Poor response to levodopa - all

Early involvement of the autonomic nervous system (orthostatic hypotension, ED, incontinence, anhydrosis) - MSA

Early onset of postural instability with frequent falls (PSP)

Dementia - DLB

Question 7

Important differentiating signs of Parkinson-plus syndromes:

MSA:
- What is the main differentiating symptom?

PSP:
- What are the main 2 differentiating symptoms?

CBD:
- What are the main 2 differentiating symptoms?

DLB:
- What is the main differentiating symptom?

Answer 7

Autonomic dysfunction
with urogenital problems

Vertical gaze palsy
Frontal lobe disturbances

Asymmetric motor symptoms
Alien limb phenomenon

Lewy bodies
Visual hallucinations