Parkinson's

Question 1

Define Parkinsonism

Answer 1

A clinical syndrome of Bradykinesia + atleast one of:

• Tremors
• Rigidity
• Postural Instability

Question 2

Describe the epidemiology of parkinson’s?

Answer 2

2nd commenest neurodegenerative disorder after Dementia.

Its age dependant and more common in males

Question 3

How does Parkinsons work?

Answer 3

Gradual loss of dopaminergic neurons in the basal ganglia (particularly the Substantia Nigra)

This makes people slow to enact movements and have problems inhibit inappropriate ones

Question 4

What causes parkinsonism?

Answer 4

• Drug Induced (Dopamine Antagonists)
• Vascular (mini-strokes to basal ganglia)
• Idiopathic (Include Lewy Body Dementia)
• Parkinson’s Plus Sydromes

Question 5

What are parkinsons plus syndromes?

Answer 5

Parkinsonism as part of a multi-system atrophy such as corticobasal degeneration

Question 6

How do you diagnose parkinsonism?

Answer 6

• The symptoms
• Should be slowly progressive (over 5-10 yrs)
• Symptoms will often be assymetric
• Response to treatment

Question 7

How do image Parkinsons?

Answer 7

Dopamine Transporter SPECT (a functional imaging technique)

It will show up asymmetric reduction of activity in the basal ganglia

Question 8

What do we treat parkinson’s with?

Answer 8

• Levodopa (a dopamine precursor)
• Oral Dopamine Agonists
• Functional Neurosurgery (i.e. Deep Brain Stimulation)
• Care packages and Occ/Physiotherapy

Question 9

What can we do to improve the half life of levodopa?

Answer 9

• MAO-B inhibitors
• COMT inhibitors
• Slow Release Levodopa

Question 10

What are the complications of parkinson’s?

Answer 10

• Depression
• Dementia (E.g. Lewy Body)
• Speech and balance issues
• Autonomic (E.g. problems controlling BP & continence)

Question 11

What -ve effects can levodopa treatment have?

Answer 11

• Motor Fluctuations as it eventually wears off
• Dyskinesias
• Psychiatric problems such as hallucinations or loss of impulse control

Question 12

What are the non-motor presentations of parkinson’s?

Answer 12

Progressive:

• Cognitive Impairment (Dementia)
• Incontinence / increase in frequency/urgency
• Drool
• ~/visual Hallucinations
• ~Anosmia