A clinical syndrome of Bradykinesia + atleast one of:
- Postural Instability
Describe the epidemiology of parkinson’s?
2nd commenest neurodegenerative disorder after Dementia.
Its age dependant and more common in males
How does Parkinsons work?
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
What causes parkinsonism?
- Drug Induced (Dopamine Antagonists)
- Vascular (mini-strokes to basal ganglia)
- Idiopathic (Include Lewy Body Dementia)
- Parkinson’s Plus Sydromes
What are parkinsons plus syndromes?
Parkinsonism as part of a multi-system atrophy such as corticobasal degeneration
How do you diagnose parkinsonism?
- The symptoms
- Should be slowly progressive (over 5-10 yrs)
- Symptoms will often be assymetric
- Response to treatment
How do image Parkinsons?
Dopamine Transporter SPECT (a functional imaging technique)
It will show up asymmetric reduction of activity in the basal ganglia
What do we treat parkinson’s with?
- Levodopa (a dopamine precursor)
- Oral Dopamine Agonists
- Functional Neurosurgery (i.e. Deep Brain Stimulation)
- Care packages and Occ/Physiotherapy
What can we do to improve the half life of levodopa?
- MAO-B inhibitors
- COMT inhibitors
- Slow Release Levodopa
What are the complications of parkinson’s?
- Dementia (E.g. Lewy Body)
- Speech and balance issues
- Autonomic (E.g. problems controlling BP & continence)
What -ve effects can levodopa treatment have?
- Motor Fluctuations as it eventually wears off
- Psychiatric problems such as hallucinations or loss of impulse control
What are the non-motor presentations of parkinson’s?
- Cognitive Impairment (Dementia)
- Incontinence / increase in frequency/urgency
- ~/visual Hallucinations