Parkinson's disease

Question 1

What is onset of Parkinson’s?

Answer 1

1. insidious onset

2. chronic progressive

Question 2

What is mean age on onset for Parkinson’s disease?

Answer 2

60years

Question 3

What is the distribution for Parkinson’s?

Answer 3

asymmetrical

Question 4

What are RF for parkinson’s disease?

Answer 4

1. Increasing age
2. Hx of familial PF in younger onset disease
3. Mutation in gene encoding glucocoerberosidase
4. MPTP exposure

Question 5

What is the pathophysiology of Parkinson’s disease?

Answer 5

1. Loss of dopaminergic neurons in substantia nigra

2. Lewy bodies in basal ganglia, brainstem and cortex

Question 6

What are the signs and symptoms of Parkinson’s disease?

Answer 6

1. Resting tremor
2. Rigidity: cogwheel (hypertonia)
3. Bradykineasia: slow to intiate movement
4. Postural instability
5. Autotomic dysfunction

Question 7

What is the resting tremor like in PD?

Answer 7

4 to 6 Hz tremor at rest, asymmetrical, pillrolling over thumb and fingers

Question 8

What are signs of autonomic dysfunction?

Answer 8

postural hypotension, constipation, urinary urgency and dribbling of salvia

Question 9

What are possible DDx of PD?

Answer 9

1. Essential tremor
2. Progressive supranuclear palsy (PSP)
3. Multiple system, atrophy
4. Lewy body dementia
5. Alzheimer’s disease with parkinsonism
6. Drug-induced parkinsonism (symmetrical and Hx)

Question 10

What investigation should you do in PD?

Answer 10

dopaminergic agent trial: improvement in symptoms

Question 11

What other investigations can you consider for PD?

Answer 11

• MRI brain to rule out structural

- If symmetrical think of other pathology

Question 12

What is the 1st line treatment for PD?

Answer 12

1. MAO-B inhibitor
2. dopaminergic agent
3. amantadine
4. trihexyphenidyl
   e. g. levodopa or rasagiline

Question 13

What are other possible treatments for PD?

Answer 13

1. Deep brain stimulation (with refractory tremor)
2. Additional Carbidopa
3. COMT inhibitor

Question 14

What are possible complications of PD?

Answer 14

1. Levodopa-induced dyskinesias
2. Motor fluctuations
3. Dementia
4. Constipation
5. Psychosis
6. Depression
7. Anxiety
8. Impulse control disorder

Question 15

What is the patho of Parkinson’s disease?

Answer 15

1. Misfolded alpha synuclein builds up

2. Lewy bodies and Lewy neutrites

Question 16

What goes under ‘parkinsinosm’?

Answer 16

• Parkinson’s
• Drug induced
• Atypical Parkinsonisms

Question 17

What are the 6 M’s of Parkinson’s?

Answer 17

1. Monotonous, hypotonic speech
2. Micrographia
3. March a petit pas
4. Misery (depression)
5. Memory loss (dementias)
6. HypomiMesis

Question 18

What are different types of gait?

Answer 18

1. Ataxic
2. Hemiplegic
3. Scissor gate
4. Choreiform
5. Shuffling

Question 19

What is ataxic gait assoicated with?

Answer 19

erebellar sign, seen in Wernicke’s encephalopathy

Question 20

What is hemiplegic gait assoicated with?

Answer 20

stroke

Question 21

What is scissor gait associated with?

Answer 21

cerebral palsy

Question 22

What is choreiform gait associated with?

Answer 22

Huntington’s

Question 23

What is shuffling gait associated with?

Answer 23

Parkinsons

Question 24

What are different types of atypical parkinsonisms?

Answer 24

1. multiple system atrophy (MSA)
2. progressive supranuclear palsy (PSP)
3. corticobulbar degeneration
4. vascular parkinsonism
5. lewy body dementia

Question 25

What is MSA associated with?

Answer 25

early autonomic and cerebellar features and Papp-Lantos bodies

Question 26

What is PSP associated with?

Answer 26

early postural instability and vertical gaze palsy

Question 27

What is corticobulbar degeneration associated with?

Answer 27

alien limb phenomenon

Question 28

What is vascular parkinson associated with?

Answer 28

Legs particularly affect and gait worse than tremor

Question 29

What is Lewy body dementia associated with?

Answer 29

early dementia and visual hallucinations