Parkinsons Disease Definition Aetiology PD vs Parkinsonism Symptoms and signs Differentials Investigations Management Prognosis 1 What is the definition of Parkinsons disease 1 What is the definition of Parkinsons disease ID: 479035
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Slide1
Erica Partridge
Parkinson’s DiseaseSlide2
Definition
Aetiology
PD
vs
Parkinsonism
Symptoms and signs
Differentials
Investigations
Management
PrognosisSlide3
1. What is the definition of Parkinson’s disease?Slide4
1. What is the definition of Parkinson’s disease?
A movement disease characterised by
Tremor at rest
Rigidity
BradykinesiaSlide5
2. Aetiology of PDSlide6
2. Aetiology of PD
Degeneration of
dopaminergic
pathways in the
substantia
nigraSlide7
4. What is the difference between PD and Parkinsonism?Slide8
4. What is the difference between PD and Parkinsonism?
PD is used to describe idiopathic syndrome of Parkinsonism
Parkinsonism is symptoms attributable to an underlying causeSlide9
5. Causes of ParkinsonismSlide10
5. Causes of Parkinsonism
Drug induced
Any drug that blocks dopamine receptors or reduce storage of dopamine
Mainly antipsychotics
But also
antiemetics
such as
metoclopramide
Antihistamines – eg
cyclizine
5HT3 receptor blockers – eg
ondansetron
Dopamine blockers eg
metoclopramide
,
domperidone
Following encephalitis
Exposure to toxins – manganese dust, sever CO
poisioningSlide11
6. 3 main features of PDSlide12
6. 3 main features of PD
Tremor
4-6
hz
Seen at rest – can be induced by concentration
Usually apparent in one limb or one side first
Rigiditiy
Increase in resistance to passive movement
Can produce a characteristic flexed posture
Cogwheel rigidity
Bradykinesia
Slowness of voluntary movement
Reduced arm swing
Progressive reduction in amplitude of repetitive movementsSlide13
7. How does PD presentSlide14
7. How does PD present
Insidious onset
Peak age of onset is 55-65, slightly more common in men
Impairment of dexterity
Progressive disorderSlide15
8. Other symptomsSlide16
8. Other symptoms
Fixed facial expression
Infrequent blinking
Quiet voice
Micrographia
Gait – short shuffling steps (
festination
), difficulty in initiating movement and in stopping
Non motor
Anosmia
Depression
Dementia
Visual hallucinations
REM sleep disordersSlide17
9. Differential diagnosisSlide18
9. Differential diagnosis
Benign essential tremor
Far more common – worse on movement, rare at rest
Drug or toxin inducedSlide19
10. In which type of dementia do patient’s have PD symptoms?Slide20
10. In which type of dementia do patient’s have PD symptoms?
Lewy
body dementia
Dementia
Fluctuating levels of awareness
Signs of mild PD
Visual hallucinations
Sleep
disorgers
PD dementia
Dementia
occuring
>1 year after PD diagnosis
Visual hallucinations
Fluctuating luciditySlide21
11. Diagnosis of PD Slide22
11. Diagnosis of PD
Bradykinesia
plus one of following
Muscular rigidity
Resting tremor
Postural instability
Not causes by primary visual, vestibular,
cerebellar
or
proprioceptive
dysfunctionSlide23
12. InvestigationsSlide24
12. Investigations
Diagnosis is clinicalSlide25
13. ManagementSlide26
13. Management
Levodopa
Taken with a
decarboxylase
inhibitor
Start with low dose and build up
Keep dose as low as possible
N+V/loss of appetite
Dopamine agonists
Eg
bromocriptine
,
cabergoline
Monotherapy
or adjuvant
COMT inhibitors
Must be taken with
levodopa
Eg
entacapone
,
tolcaponeSlide27
MAOBi
Prevent dopamine being broken down
Selegine
Has amphetamine metabolites – hallucinations, nightmares, confusion so avoid in elderly
Rasagiline
No amphetamine metabolitesSlide28
Levodopa
Breakdown product
Breakdown product
Breakdown product
Dopamine
COMT
MAO
COMT
AADC
(
decarboxylase
)
BBBSlide29
14. Other management Slide30
14. Management
OT
SALT
Exercises to strengthen voice/help control facial expression/swallowing or drooling problems
Suggest communication aids
Physio
PD nurse
Support groupsSlide31
15. Common management problemsSlide32
15. Common management problems
Motor fluctuations – associated with long term L-dopa
On off fluctuations – occur randomly
Wearing off phenomenon – before next dose is due
Involuntary movements while on –
dyskinesias
Axial problems
Do not respond to treatment
Balance, speech and gait
Physio
, SALT, OT
Associated disease
Dementia (20-40%)
Depression (45%)Slide33
16. ComplicationsSlide34
16. Complications
Infections
Aspiration pneumonia
Bed sores
Poor nutrition
Falls
Contractures
Bowel and bladder disordersSlide35
17. PrognosisSlide36
17. Prognosis
Slowly progressive with mean duration of 15 years
Severity is hugely varied
Some show little disability after 20 years
Others severely disabled after 10 yearsSlide37
Explaining things to patientsSlide38
Explaining things to patients
What do they already know
Why they need it
What will happen
Risks/side effects
Do they have any questions?
It is fine if you don’t know the answers say you will find out and get back to them
Offer to give them information sheets/leafletsSlide39
References
Patient UK Professional Reference
NICE guidelines
Parkinson’s
UK website