Parkinson's

Question 1

What is Parkinson’s disease?

Answer 1

A chronic progressive neurological disorder characterised by motor symptoms of resting tremor, hypertonia, bradykinesia, and postural instability.

Question 2

What is the presentation of Parkinson’s? (motor)

Answer 2

Tremor: pill-rolling, worst at rest

Hypertonia: cogwheel rigidity

Bradykinesia: slow to initiate movement, micrographia, expressionless face

Question 3

What are non-motor Parkinson’s symptoms?

Answer 3

Autonomic: postural hypotension, constipation, urinary frequency

Sleep disturbance

Reduced sense of smell

Depression, dementia, psychosis…

Question 4

What are differentials of idiopathic Parkinson’s?

Answer 4

Essential tremor
Dementia with Lewy bodies
Supranuclear palsy and multisystem atrophy (Parkinson’s +)
Drug induced

Question 5

How is Parkinson’s diagnosed?

Answer 5

Clinical

Signs usually worse on one side then progress to both

Functional neuroimaging e.g. Datscan can be doen

Question 6

What are the management options for Parkinson’s?

Answer 6

Levodopa (+carbidopa)

Dopamine agonists

COMT (+levodopa) /MAOB inhibitors

Treat patients with significant motor Sx with levodopa; if not affecting QOL can start with other drugs.

If a patient continues to have symptoms despite optimal levodopa treatment or has developed dyskinesia then NICE recommend the addition of a dopamine agonist, MAO‑B inhibitor or catechol‑O‑methyl transferase (COMT) inhibitor as an adjunct.

Question 7

What are complications of Parkinson’s?

Answer 7

Dyskinesia
Impulsive behaviours
Neuroleptic malignant syndrome