Parkinson's disease

Question 1

What is the definition of Parkinson’s disease?

Answer 1

• Akinetic rigid syndrome

* Movement disorder

Question 2

How common is Parkinson’s disease?

Answer 2

93.1 in 100,000 person years between 70 and 79 years old

Question 3

What is the pathophysiology of Parkinson’s disease?

Answer 3

• Neurodegenerative disease
• Depletion of dopamine secreting cells in the substatia nigra (zona compacta)
• = alternation in neural activity of the non striatal pathway that leads to the basal ganglia – the part of the brain that regulates movements
• Cell loss due to abnormal accumulation of alpha-synyclein bound to ubiquitin → forms Lewy bodies

Question 4

What are the risk factors/aetiology of Parkinson’s disease?

Answer 4

• ↑ age
• Men
• MPTP (methylphenyl-terthahydropyridine) – an impurity formed during the illegal synthesis of opiates
• Survivors of encephalitis lethargica
• Genetic – mutation in the α-synuclein and ubiquitin carboxylterminal hydrolase L1 gene
• Drug induced e.g. reserpine, phenothezines etc
• Parkinsonism plus – parkinsonism and evidence of a separate pathology
• Progressive supranuclear palsy
• Multiple system atrophy
• Multi-infarct dementia – causes parkinsonism
• Repeated head injury – causes parkinsonism

Question 5

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

Answer 5

• Resting tremor
• 4-7Hz
• Most obvious in hands ‘pill rolling’
• Improved by voluntary movements
• Made worse by anxiety
• Rigidity/↑ tone
• Lead pip rigidity
• Cogwheel
• Bradykinesia
• Difficulty initiating movements
• Face = expressionless
• Speech is slow and monotone
• Writing is small and tails off at the end of the line
• Shuffling gait
• Neuropsychiatric symptoms
• Depression
• Hallucinations
• Dementia
• Impulsive behaviours
• Sleep disorders
• GI and autonomic disorders
• Drooling
• Excessive sweating
• Dysphagia
• Constipation
• Fatigue
• Weight loss
• Death normally resulting from bronchopneumonia

Question 6

What investigations are carried out when Parkinson’s disease is suspected?

Answer 6

• Clinical diagnosis

* MRI/CT – to distinguish if parkinsonism of a different cause

Question 7

What are the surgical treatments for Parkinson’s disease?

Answer 7

• Stereotactic neurosurgery

Question 8

What are the pharmacological treatments for Parkinson’s disease?

Answer 8

• Levodopa +/- catechol-O-methyl transferase inhibitor
• Dopamine agonists
• Monoamine oxidase B inhibitors
• SSRI’s – for depression

Question 9

What are the non pharmacological treatments for Parkinson’s disease?

Answer 9

• Physiotherapy

* Information and support via the Parkinson’s Disease Society