Parkinosons Disease (PD)

Last updated 25.08.13

 

Index

 

Definition

-  Chronic

 

Features

-  Asymetrical onset

-  Typically 60 years plus

-  Idiopathic

 

Dx (2 of 3)

-  Rigidity

-  Cogwheel

-  Resting tremor

-  Increases with stress

-  Stops with sleep

-  Pill rolling

-  Bradykinesia

-  Micrographia

-  Hypophonia

-  Mask like facies

-  Festenation (propogating gait)

-  Postural instability

-  Evolves after 8+ years

-  If present earlier suspect PSP

-  S/S improve with Dopamine

 

Associated S/S

-  Gait

-  Wide based

-  Decreased arm swing

-  Decreased stride length

-  Festenation

-  Ataxia

-  ANS Dysfuction

-  Tremor

-  Depression

-  Constipation

-  Fatigue

-  Sleep disorders

 

DDx

-  PSP (Progressive Supranuclear Palsy)

-  Earlier falls

-  Gaze palsies

-  No tremor

-  No/little improvement w Dopamine

-  Comorbid Dementia

-  Diffuse Lewey Body Dementia

-  Dementia s/s before pyramidal or within 1 year

 

Management

- Dopamine agnoist

- Levidopa & Carbidopa (peripheral decaroxylase inhibitor)

-  On-Off phenomenon

-  Dyskinesias

- Deep brain stimulation

-  Thalamic

-  Pallidal