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Parkinson's Disease

A Mind Odyssey

Parkinsons Disease

    Clinical features & diagnostic criteria

    Lecture notes from Dr R Barber, Consultant Geriatrician.

    Lecture contents:

  • Important Differential Diagnoses
  • Science
  • Therapy

U.K. P.D.S. Brain Bank Criteria:

Parkinsonian Syndrome =

  1. Bradykinesia and at least 1 of:
  2. Rigidity
  3. Rest Tremor
  4. Postural instability

Exclusions for Idiopathic PD

Supportive prospective positive criteria for IPD

Differential Diagnosis - Traps

  1. Benign Essential Tremor
  2. Dystonic Tremor
  3. Progressive Supranuclear Palsy (PSP)
  4. Multi System Atrophy (MSA)

Benign Essential Tremor (B.E.T.)

Common

Action (rest if severe)

Symmetrical -ish

Doesnt start in legs

May involve Neck & Voice

No Rigidity, no Bradykinesia

Cogwheeling may be present

Dominant inheritance often

Relieved by alcohol, b blockers, not L dopa

Progressive supranuclear palsy (P.S.P.)

Paresis of downward gaze

Dysarthria

Parkinsonian

Dementia

Relentlessly Progressive

M>F

Poor response to L-dopa

? Family history

 

Multi system atrophy

Spectrum of 3 clinical syndromes:

Primary autonomic failure (Shy-Drager)

orthostatic hypotension, impotence, diarrhoea, retention.

Striatonigral degeneration (Parkinsonism)

Olivo-ponto-cerebellar degeneneration (Cerebellar)

               Poor response to L dopa

 

Dementia with Lewy Bodies

Cognitive impairment prominent, often before Parkinsonism

Fluctuating Cognitive Function

Falls

Hallucinations

Some response to L-dopa

Sensitivity to neuroleptics

 

Part 2.

Non Motor aspects of P.D.

Bladder

incontinence, frequency / urgency

Bowels

Constipation, bloating, nausea

Bulbar

Hypersalivation, drooling, dysphagia

Speech

Dysarthria, hypophonia, initiation

Visual

diplopia, blepharospasm, blepharoclonus

Skin

Seborrhoea, hyperhidrosis

Weight loss

Autonomic dysfunction > falls etc.

Psychological

depression, apathy, anxiety

Cognitive

Dementia, confusion, hallucination

Sleep disturbance

REM disorder, Akathisia, somnolence

Pain

dystonia, rigidity

Sexual

impotence, erectile & psychogenic

 

3. Take Home messages

Diagnosis difficult

PD brain bank criteria

DAT/PET scan if available?

Treat when symptoms start interfering

Low and Slow

Dopamine agonists 1st. in younger

L dopa 1st. in older elderly

Selegiline?

Add L dopa or Dopamine agonist later

Watch for end dose fading

Add COMT inhib.

Apomorphine?

Amantadine?

Surgery ( in younger )?

Watch this space

SE s of medication

GI - nausea, diarrh., abdo pain

Dyskinesia

Neuro psych. -confusion, hallucinations

Postural Hypotension

DONT FORGET OTHER BITS

Constipation

Depression

Dementia

Incontinence/ Frequency-Urgency

Sleep disturbance

Help at home

Groups / PDS for moral support