PARKINSONS DISEASE

Question 1

What is Parkinson disease?

Answer 1

It is a neurodegenerative disease due to the progressive depletion of dopaminergic neurons in the basal ganglia specifically in the substantia nigra.

Question 2

What is the role of dopamine in Parkinson?

Answer 2

It is a neurotransmitter that regulates smooth and controlled body movements

Question 3

What is the pathologic hallmark of Parkinson disease?

Answer 3

Degeneration of the dopaminergic neurons in the substantia nigra pars compacta

Question 4

What is the common age of manifestation for Parkinson’s?

Answer 4

60 years and above

Question 5

Causes of Parkinson’s

Answer 5

Genetics - mutations in a-Synuclein (SNCA), GBA, Parkin (Park2) genes
Family history
Pesticide/chemicals exposure

Question 6

What is Parkinsonism?

Answer 6

It is a triad of tremors, hypertonia and bradykinesia

Question 7

What is cogwheel rigidity usually from?

Answer 7

A combination of rigidity and tremor usually felt during rapid supination and pronation

Question 8

What is postural instability and when does it appear in Parkinsons?

Answer 8

It is imbalance and tendency to fall. It normally manifests in the later stages of Parkinson’s

Question 9

What is secondary Parkinsonism?

Answer 9

It is Parkinsonism that is from causes other than a neurodegenerative disease such as intoxication, traumatic brain injury or medication.

Question 10

What is atypical Parkinsonism?

Answer 10

It is Parkinsonism from causes other than Parkinson disease. It is also called Parkinson plus syndromes

Question 11

What is drug induced Parkinsonism?

Answer 11

It is also called pseudo Parkinsonism and is the most common cause of secondary Parkinsonism. It is caused by drugs with anti dopaminergic effects such as antipsychotics ( haloperidol) , some antiemetics (metoclopramide), some calcium channel blockers (cinnarizine, flunarizine) etc

Question 12

What are the metabolic disorders that can cause secondary Parkinsonism ?

Answer 12

Examples are Wilson’s disease, hemochromatosis

Question 13

Are motor signs unilateral or bilateral on onset of Parkinson’s?

Answer 13

Unilateral initially then can progress to bilateral. This is specifically characteristic of PD over other forms of Parkinsonism

Question 14

Are motor signs symmetrical or asymmetrical in Parkinsons?

Answer 14

They are asymmetrical meaning one side is worse than the other

Question 15

What is bradykinesia?

Answer 15

Decrease in speed and amplitude of movement

Question 16

Motor signs of PD

Answer 16

Bradykinesia
Resting tremor
Pill rolling tremors
Hypertonia
Cogwheel rigidity
Postural instability
Parkinsonian / shuffling gait
Festinate gate (small increasingly quickened steps)
Forward leaning gait (propulsion)
Decreased arm swing

Question 17

What is the glabella tap test?

Answer 17

Glabellar reflex is when patient blinks every time repeatedly as the glabella is tapped which indicates frontal lobe dysfunction because ideally they should stop blinking after the first few taps

Question 18

Other motor signs in PD

Answer 18

Positive glabellar test
Dystonia
Stooped posture
Micrographia - extremely tiny handwriting
Hypomimia - minimal facial expressions