Parkinson’s disease

• Paralysis agitans

• 332.0 Paralysis agitans

• G20 Parkinsonism (idiopathic) (primary)

• 5E: Impaired Motor Function and Sensory Integrity Associated with Progressive Disorders of the Central Nervous System

Description

• Progressive degenerative disorder of the central nervous system
• Death of dopamine-producing cells in the substantia nigra
• Named after English MD, James Parkinson
• Parkinsonian syndromes (4 types)
  • Primary or idiopathic, no known cause
  • Secondary or acquired
  • Hereditary parkinsonism
  • Parkinson plus syndrome or multiple system degeneration

Essentials of Diagnosis

• Core features include a tetrad of hypo- or bradykinesia, resting tremor, postural instability, and rigidity
• Some people have a rigidity-dominant presentation; others have a dyskinesia-dominant presentation (predominantly those with onset at a young age)
• Pathophysiology

General Considerations

• Positive diagnosis of PD is made with a successful levodopa (l-dopa) trial

Demographics1

• Onset generally between 45 to 70 years of age
• More common in men
• Impacts all ethnic groups and socioeconomic classes
• Most cases are idiopathic; genetic variants exist, but are rare

Signs and Symptoms

• Tremor: usually asymmetrical
• Gait disturbance, usually described as “festinating”
• Postural instability
• Stooped posture
• Stiffness/rigidity: begins on one side
• Slowness of movement
• Dizziness
• Freezing of movement
• Bradykinesia or hypokinesia
• Muscle ache
• Loss of dexterity
• Mask-like facial expression
• Micrographia (small, cramped handwriting)
• Depression
• Neuropsychiatric problems
• Speech disturbance: decreased volume and pitch, as well as motoric loss
• Dementia in the later stages of the disease
• Loss of smell
• Constipation

Functional Implications

• Progressive loss of
  • Balance reactions
  • Ambulation ability and safety
  • Respiratory capacity to support activity
  • Interaction with home and community environments

Possible Contributing Causes

• Unknown
• Drug-induced parkinsonism (DIP)

Differential Diagnoses

• Hemiparkinson-hemiatrophy syndrome
• Progressive supranuclear palsy (PSP)
• Basal ganglia tumors
• Vascular pathology
• Multiple system atrophy (MSA)
• Lewy body disease
• Corticobasal ganglionic degeneration (CBGD)
• Encephalitis
• Pseudobulbar palsy
• Binswanger’s disease
• Normal-pressure hydrocephalus (NPH)
• Multiple sclerosis (MS)

Laboratory Tests

• Blood test to help rule out other disorders

Imaging

• Positron emission tomography (PET) scan
• Magnetic resonance imaging (MRI) and Computed tomography (CT) usually normal

Diagnostic Procedures

• Confirmation is made by a positive response to l-dopa trial in a patient with the tetrad of symptoms brady- or hypokinesia, resting tremor, postural changes and instability, cogwheel rigidity

• PET scan would demonstrate decreased activity in the basal ganglia

Medications

• Sinemet®
• Ropinirole
• Symmetrel®
• Cogentin®
• Entacapone
• Rasagiline
• Selegiline

• To neurologist for imaging; disease management
• To neurosurgeon for deep brain stimulation
• To the National Parkinson Foundation for support

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