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Parkinson's Disease

Definition

A neurodegenerative disease affecting motor and cognitive functions

 

Risk factors

  • Male
  • Age
  • Family history/genetics
  • Heavy metal exposure
  • MPTP exposure (impurity in some recreational drugs)

 

Differential diagnoses

  • Alzheimer’s disease
  • MS
  • Stroke
  • Lewy body dementia
  • Drug-induced parkinsonism (eg in treatment for schizophrenia)
  • Infection

 

Epidemiology

  • Affects males more than females
  • Average age of onset is 65
  • Generally sporadic

 

Aetiology

  • Is a result of brain atrophy, specifically of dopaminergic neurons in the substantia nigra and associated areas
  • Accumulation of Lewy bodies in these dopaminergic areas (aggregated bodies of α-synuclein)

 

Clinical features

  • Diagnosis requires:
    • Bradykinesia
    • Resting tremor (often ‘pill rolling’) and/or rigidity
  • Other motor symptoms:
    • Shuffling gait
    • Stooped posture
    • Balance problems, especially when turning
    • Hypomimia (‘masked’ face)
    • Dystonic postures
    • Freezing
  • Non-motor symptoms:
    • GI problems, eg constipation, dribbling, nausea
    • Sleep problems
    • Cognitive problems, eg depression, memory loss, executive dysfunction, dementia
    • Neurocognitive problems eg hallucinations, delusions
    • Autonomic problems, eg incontinence/urgency, sexual dysfunction, orthostatic hypotension
    • Pain, paraesthsia

 

Pathophysiology

  • Is a result of brain atrophy, specifically of dopaminergic neurons in the substantia nigra and associated areas
  • Accumulation of Lewy bodies in these dopaminergic areas (aggregated bodies of α-synuclein)

 

Investigations

  • MRI brain
  • Exclusion of other causes
  • Trial of dopaminergic agent (eg L-Dopa), would expect symptom improvement

 

Management

  • Dopamine replacement, eg L-dopa
  • Deep brain stimulation
  • Medical device to aid mobility eg orthoses, wheelchair
  • Physical therapy

 

Prognosis

  • Progressive disease, causing disability and may severely affect quality of life
  • May not affect life expectancy, especially in those diagnosed later in life
  • Younger diagnosis – likely to reduce life expectancy, but is varied
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