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Erica Partridge - PowerPoint Presentation

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Erica Partridge - PPT Presentation

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

parkinsonism dementia dopamine management dementia parkinsonism management dopamine diagnosis symptoms disease movement visual common parkinson

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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