Parkinsons disease

Question 1

Parkinsons definition

Answer 1

Neurodegenerative disease
Breakdown of dopamine receptors in the substantia nigra/basal ganglia

Question 2

Signs in parkinsons disease

Answer 2

Hypomimia - expressionless facies
Assymetrical hand tremor
Bradykinesia
Leadpipe + cogwheel ridgidity
Hypophonia -> quiet voice
Festinating gait -> reduced arm swing, difficulties turning, shuffling
Micrographia
Anosmia
Autonomic dysfunction
REM sleep disturbance

Question 3

Parkinsons plus syndromes

Answer 3

Progressive supranuclear palsy
Multiple systems atrophy
Corticobasal degeneration

Question 4

Causes of Parkinsonism

Answer 4

Idiopathic parkinsons disease
PSP
Multiple systems atrophy - Orthostatic hypotension + Cerebellar sx
Corticobasal degeneration
Dementia w/ lewy bodys (visual hallucinations)
Wilsons disease
Drugs -> Metoclopramide, Prochlorperazine

Question 5

Investigations of Parkinsons

Answer 5

Clinical diagnosis
Consider structural imaging to rule out other causes

Question 6

Management of Parkinsons (Conservative)

Answer 6

MDT approach:
SALT -> swallow assessment
PT -> help with gait issues
OT -> Help maintain function w/ adaptations
Parkinsons specialist nurses

Question 7

Management of Parkinsons (Medical)

Answer 7

Levodopa + peripheral dopa-decarboxylase inhibitor -> Co-careldopa
Dopamine agonists -> Pergolide
MAO-B inhibitors -> Selegeline -> reduces breakdown of dopamine
COMT inhibitors -> Entacapone -> reduced breakdown of L-dopa