Parkinson's

Question 1

Parkinson’s Defintion

Answer 1

Movement disorder characterised by

• Tremor at rest
• Rigidity
• Bradykinesia

Diagnosis based on clinical examination

Question 2

Parkinson’s Pathogenesis

Answer 2

• Reduction of dopamine in substantia nigra
• Can be drug induced
• Can occur following encephalitis or toxin exposure

Question 3

Parkinson’s Epidemiology

Answer 3

• Second most common neurodegenerative disorder after Alzheimer’s
• Between 55-65
• More common in men

Question 4

Parkinson’s RFs

Answer 4

• Male sex
• Pesticide exposure
• Being born in spring

Question 5

Parkinson’s Presentation

Answer 5

• Insidious onset with peak age of onset 55-65
• Commonly presents with impaired dexterity or slight dragging of one foot
• Fixed facial expression with infrequent blinking
• Tremor at rest at 4-6Hz (spiral)
• Rigidity
• Bradkinesia

Later features
-Gait disturbance

Question 6

Parkinson’s Diagnostic Criteria

Answer 6

• UK Parkinson’s disease Society Brain Bank Criteria
• Bradykinesia with one of
• Muscular rigidity
• 4-6Hz resting tremor
• Postural instability not caused by visual, vestibular, cerebellar or proprioceptive dysfunction)

(As well as three or more of

• Unilateral onset
• Resting tremor
• Progressive
• Response to L-dopa…)

Question 7

Parkinson’s Long-Term Problems

Answer 7

• After initial period those on L-dopa may experience:
• Motor fluctuations
• On/Off syndrome
• Wearing off of treatment
• Axial problems
• Parkinson’s dementia (similar to Alzheimer’s but with Parkinsonism, visual hallucinations and lucidity fluctuations)

Question 8

Parkinson’s Differentials

Answer 8

• ET
• Drug induced
• Huntington’s
• LBD

Question 9

Parkinson’s Referral

Answer 9

-Refer to specialist quickly and untreated

Question 10

Parkinson’s Ix

Answer 10

• Clinical diagnosis
• CT/MRI for those who fail to respond to treatment
• SPECT to can differentiate between PD and ET

Question 11

Parkinson’s Management

Answer 11

• Levodopa
• MAO-Bi (early treatment can delay need for levodopa)
• Dopaminergic agent or
• Amantadine or
• Trihexyphenidyl