Parkinsons Disease

Definition
- Triad of tremor, rigidity and bradykinesia
- The disease is slowly progressive, without remission.
Epidemiology
- Mean age of onset between 45-60 Prevalence is 0.5-1% of the over 60s in
the UK 2nd most common neurodegenerative disease (after Alzheimer's)
Pathophysiology
- Results from the loss of dopaminergic neurons in the basal ganglia, most
notably the substantia nigra. Surviving neurons contain aggregations of Lewy
bodies.
- Symptoms of PD are only seen once levels of dopamine are 20-40% that of
normal.
- There is no obvious cause for this loss of neurons.
Causes
- Idiopathic
- Drugs (eg: phenothiazines)
- Heavy metal poisoning
- CO poisoning
Signs and symptoms
-

Tremor (4-7 Hz, pill rolling)

Rigidity (an increase in limb tone; typically assymetric)

Bradykinesia (slow movement + difficulty initiating movement)

Shuffling gait with poor arm swing

Postural instability (stooped posture)

Speech- monotonous, dysarthric

Psychiatric- depression,
hallucinations

Reduced facial expression hypomimea, dribbling

Micrographia (small handwriting)

anxiety,

somulance,

vivid

dreams,

Common presenting complaints- constipation,

depression, anxiety, sleep disturbance

anosmia,

falls,

Hallucinations are common, and are thought to be a combination of

both the disease and the drugs used to treat it. Often they are not
unpleasant.

Differential diagnosis
- Essential tremor
- Drug-induced parkinsonism
- Wilsons disease
- Multiple-system atrophy (MSA)
- Lewy-body dementia
Diagnosis
- Diagnosed by clinical history & examination
- Must have bradykinesia + tremor/ disorder of posture balance or gait
- The aim is to distinguish between idiopathic PD & other causes of
Parkinsonism syndromes.
- Bloods including TSH, copper and U& Es, CT brain, DAT scan

Treatment

Levodopa (L-dopa)
- to improve stiffness, slowness and tremor
- effects wears off with time
- side effects include nausea, confusion, psychiatric disturbances

Dopamine agonists
- to manage motor symptoms

Monoamine oxidase type B (MAO-B) inhibitors

- -Stops dopamine breakdown

Anticholinergics
- to help motor functions
Management should include:
- Patient & carer education
- MDT approach
- Pharmacological therapy

Regular follow up

Complications
- Neuropsychiatric complications occur in 50% of PD patients
- Tricyclics and SSRIs may help depression.
- Psychosis and dementia often complicate PD