Parkinson's Disease

Question 1

Describe Parkinson’s Disease symptoms

Answer 1

o Bradykinesia
o Rigidity
o Resting tremor
o Postural instability

Question 2

Explain Parkinson’s Disease aetiology

Answer 2

Sporadic/Idiopathic Parkinson’s Disease
o Most COMMON
o Aetiology UNKNOWN
o May be related to environmental toxins and oxidative stress

Secondary Parkinson’s Disease
o Neuroleptic therapy (e.g. for schizophrenia)
o Vascular insults (e.g. in the basal ganglia)
o MPTP toxin from illicit drug contamination
o Post-encephalitis
o Repeated head injury

Question 3

Summarise the epidemiology of Parkinson’s disease

Answer 3

• Very COMMON
• Prevalence: 1-2% of > 60 yrs
• Mean age of onset: 57 yrs

Question 4

Recognise the presenting symptoms of Parkinson’s disease

Answer 4

• INSIDIOUS onset
• Resting tremor (mainly in hands)
• Stiffness and slowness of movements
• Difficulty initiating movements
• Frequent falls
• Smaller hand writing (micrographia)
• Insomnia
• Mental slowness (bradyphenia)

Question 5

Recognise the signs of Parkinson’s disease on physical examination

Answer 5

• Tremor
• Rigidity
• Gait
• Postural Instability
• Psychiatric
• Other features

Question 6

Describe tremor in PD

Answer 6

o Pill rolling rest tremor
o 4-6 Hz
o Decreased on action
o Usually asymmetrical

Question 7

Describe rigidity in PD

Answer 7

o Lead pipe rigidity of muscle tone
o Superimposed tremor can cause cogwheel rigidity
o Rigidity can be enhanced by distraction

Question 8

Describe gait in PD

Answer 8

o	Stooped 
o	Shuffling 
o	Small-stepped gait
o	Reduced arm swing 
o	Difficulty initiating walking

Question 9

Describe postural instability in PD

Answer 9

Falls easily with little pressure from the back or front

Question 10

Describe psychiatric disturbances in PD

Answer 10

o Depression

o Cognitive problems and dementia (in later stages)

Question 11

Describe other features of PD

Answer 11

o	Frontalis overactivation (leads to furrowing of the brow)
o	Hypomimic face 
o	Soft monotonous voice 
o	Impaired olfaction 
o	Tendency to drool
o	Mild impairment of up-gaze

Question 12

Identify appropriate investigations for Parkinson’s disease

Answer 12

CLINICAL diagnosis
Levodopa Trial
o Timed walking and clinical assessment after administration of levodopa
Bloods
o Serum caeruloplasmin - rule out Wilson’s disease as a cause of Parkinson’s disease
CT or MRI Brain
o To exclude other causes of gait decline (e.g. hydrocephalus)
Dopamine Transporter Scintigraphy
o Reduction in striatum and putamen