Parkinson's Disease Overview

A progressive movement disorder of the central nervous system, characterized by loss of dopaminergic neurons in the substantia nigra.

Loss of pigmented dopaminergic neurons in the substantia nigra, leading to the presence of Lewy bodies. This gradual neuron loss impacts motor control.

A midbrain area crucial for motor control, communicating with the basal ganglia.

Structures that coordinate voluntary movement and posture in the brain.

Abnormal protein clumps found within brain cells, characteristic of Parkinson's Disease.

A neurotransmitter essential for smooth muscle control and brain processes.

Around 120 cases per 100,000 people (varying across studies).

Symptoms usually start between ages 55-60.

A key pathway in the brain affected by PD. The loss of dopamine-producing cells in the substantia nigra leads to motor problems.

The most common movement problems in PD: tremor, bradykinesia, rigidity, and postural instability.

A shaking movement, often described as 'pill-rolling', that is most noticeable when the person is at rest.

Extreme slowness of movement, difficulty starting and performing movements, and decreased amplitude of movement.

Increased resistance to movement, making it stiff and difficult to move.

Trouble with balance and posture, often leading to falls.

Idiopathic (unknown cause) is most common; other causes include toxins, head trauma, drug-induced effects and genetic factors.

Symptoms that are not directly related to movement, such as sleep disturbances, and depression.

Parkinson's disease often presents with motor symptoms like shuffling gait, flexed posture, festination, decreased arm swing, freezing, micrographia, and painful dystonia. Problems with balance (falls) and facial expressions (hypophonia, hypomimia) also occur.

Diagnosis of Parkinson's involves a neurological examination focusing on tremor, bradykinesia (slowness of movement), rigidity (stiffness), and postural instability (balance). Assess rapid repetitive movements and look for signs of Parkinson plus syndromes.

Parkinson's plus syndromes are conditions with symptoms similar to Parkinson's but progress faster and respond less well to standard Parkinson's treatments. Autonomic dysfunction is common.

Differential diagnosis for Parkinson's considers conditions that share similar symptoms. Examples include essential tremor, vascular parkinsonism, drug-induced parkinsonism, and Parkinson's plus syndromes.

Essential tremor causes a rhythmic and sometimes excessive trembling that is not typically accompanied by other Parkinsonian symptoms like rigidity or bradykinesia.

Cognitive decline can happen in Parkinson's disease, leading to executive dysfunction and in some serious cases dementia (about 30% of cases; possibly due to Lewy Body Dementia, DLB).

A clinical assessment for Parkinson's involves gathering a detailed history, including any collateral information, and performing a careful neurological examination focusing on key symptoms.

A surgical procedure where an electrode is implanted in the brain to deliver electrical stimulation, usually targeting the thalamus or globus pallidus. This can help to reset abnormal firing patterns and improve symptoms of Parkinson's Disease.

Deep Brain Stimulation can improve symptoms that were previously responsive to levodopa, extending 'on' time and reducing dyskinesias. It can also reduce medication use.

Ideal candidates have a confirmed diagnosis of Parkinson's Disease, respond well to levodopa but experience motor fluctuations or dyskinesias, have no significant psychiatric problems, and understand the risks and benefits of the treatment.

Parkinson's Disease progresses through stages, starting with mild motor symptoms and advancing to more severe complications, finally reaching a late stage where the disease significantly impacts daily life.

Parkinson's Disease is a treatable condition, with a focus on improving function and quality of life. Levodopa remains the primary pharmacological treatment, and multidisciplinary care is crucial for managing the disease.

A nuclear medicine scan used to assess dopamine uptake in the brain. It helps distinguish Parkinson's from other disorders, but can't differentiate between different parkinsonian syndromes.

A group of disorders that mimic Parkinson's Disease, but have additional features like early dementia or problems with eye movements. Examples include Multisystem Atrophy and Progressive Supranuclear Palsy.

A neurodegenerative disease with Parkinson's-like features, but also affects the autonomic nervous system, causing problems like bladder dysfunction, postural instability, and low blood pressure.

A neurodegenerative disorder with Parkinson's-like symptoms, but characterized by early, severe eye movement difficulties, especially looking upwards, and cognitive decline.

To manage the symptoms of Parkinson's as effectively as possible for as long as possible, while minimizing side effects and maintaining quality of life.

A medication used in Parkinson's treatment to replace dopamine, the neurotransmitter lost in the disease, by converting to dopamine in the brain.

Treatment involves both pharmacological and non-pharmacological approaches. This includes medication for symptoms like tremor and stiffness, physical therapy, occupational therapy, support groups, and communication with the doctor.

Non-pharmacological management aims to improve quality of life and function through support groups, physical and occupational therapy, dietary advice, and communication with the patient's primary care physician.

Levodopa is the most effective treatment for Parkinson's Disease, but long-term side effects limit its initial use.

Long-term use of Levodopa can lead to motor fluctuations, with periods of 'on' and 'off' responsiveness.

Levodopa absorption is optimized when taken pre-meals on an empty stomach.

A common side effect of Levodopa where its effectiveness gradually decreases over time.

Treatment strategies for 'wearing off' include extended-release Levodopa at night and adding COMT inhibitors.

Sudden, temporary inability to move during Levodopa treatment.

Strategies to manage freezing episodes include increasing Levodopa dose or frequency, or adding COMT or MAO-B inhibitors.

Thalamotomy and Pallidotomy, surgical procedures that target specific brain regions to reduce Parkinson's symptoms, were common in the past but are now less frequently used.

Parkinson's Disease is a progressive movement disorder caused by the loss of dopamine-producing neurons in the substantia nigra, a part of the brain. This leads to problems with movement, coordination, and balance.

Lewy bodies are abnormal protein clumps found inside the brain cells of people with Parkinson's Disease. They are a characteristic sign of the disease.

The substantia nigra is a part of the midbrain that is crucial for motor control. It produces dopamine, a neurotransmitter needed for smooth movement.

The basal ganglia are a group of structures deep within the brain that are important for coordinating voluntary movement and establishing postures.

The cardinal symptoms of Parkinson's Disease are: tremor (shaking), bradykinesia (slowness of movement), rigidity (stiffness), and postural instability (difficulty with balance).

Diagnosing Parkinson's Disease typically involves a careful neurological examination, taking a detailed history, considering the patient's symptoms, and sometimes using imaging tests to rule out other conditions.

Dopamine is a neurotransmitter that plays a crucial role in smooth muscle control and movement. In Parkinson's, the loss of dopamine-producing neurons leads to the characteristic motor problems.

Braak staging is a system used to describe the progression of Parkinson's disease from early microscopic changes to later clinical manifestations. It helps to understand the disease process and predict the course of symptoms.

A crucial pathway in the brain connecting the substantia nigra to the striatum, using dopamine as a neurotransmitter. This pathway is affected in Parkinson's disease, leading to motor symptoms.

The four main motor symptoms of Parkinson's disease: tremor, bradykinesia, rigidity, and postural instability. Each symptom contributes to the difficulty with movement and balance characteristic of the disease.

A characteristic shaking movement, often described as 'pill-rolling', which is usually present at rest and worsens with stress. It occurs due to the imbalance of signals from the basal ganglia caused by dopamine deficiency.

Slowness of movement, difficulty initiating and performing voluntary movements, and decreased amplitude of movement. This symptom results from the decreased dopamine levels in the brain, affecting the ability to plan and execute movements.

Increased resistance to passive stretch, making muscles stiff and difficult to move. It arises from the imbalance in the basal ganglia, caused by dopamine deficiency, affecting the smooth control of muscle tone.

A loss of balance and difficulty maintaining posture, often leading to falls. This symptom is caused by the combination of bradykinesia, rigidity, and changes in the basal ganglia due to dopamine deficiency.

Most cases are idiopathic (unknown cause). Other causes include exposure to toxins, head trauma, drug-induced effects, and genetic factors. Abnormal proteosome system and oxygen free radicals might also play a role.

A neurotransmitter that is crucial for smooth muscle control and brain processes, particularly in movement control.

A deterioration in mental abilities, such as memory, thinking, and reasoning, that occurs gradually in some Parkinson's Disease cases.

Difficulty with planning, organizing, and managing time, often experienced by people with Parkinson's Disease.

These are two key signs of Parkinson Plus Syndromes. They are present early in the disease and progress more quickly than in typical PD.

A common feature in Parkinson Plus Syndromes, impacting bodily functions like blood pressure, bladder control, and sweating.

The primary treatment for Parkinson's disease, replacing dopamine to alleviate symptoms. However, long-term side effects limit its initial use.

Surgical procedures targeting specific brain regions to reduce Parkinson's symptoms, but are less frequently used today.

Taking Levodopa before meals on an empty stomach maximizes its absorption and effectiveness.

A surgical procedure involving implanting an electrode in the brain to deliver electrical stimulation, primarily targeting the thalamus or globus pallidus. This helps to reset abnormal firing patterns, improving Parkinson's symptoms.

Ideal candidates for DBS have a confirmed Parkinson's diagnosis, respond well to levodopa but experience motor fluctuations or dyskinesias, have no significant psychiatric problems, and understand the risks and benefits.

DBS can extend 'on' time, reduce dyskinesias (uncontrollable movements), and minimize medication use.

Levodopa is the mainstay of pharmacological treatment for Parkinson's Disease. It acts as a dopamine precursor, converting to dopamine in the brain, but long-term side effects limit its initial use.

Regular monitoring is crucial for Parkinson's, focusing on symptom improvement, side effects, and medication response.

A progressive neurodegenerative disorder that affects various systems in the body, primarily the brain and autonomic nervous system. It's characterized by Parkinson-like symptoms (tremor, slowness, stiffness) along with additional features such as bladder dysfunction, postural instability, and low blood pressure.

Core features of MSA include axial (trunk) > limb involvement, postural instability with falls, postural hypotension (low blood pressure), bladder dysfunction, pyramidal signs (spasticity or increased muscle tone), and cerebellar signs (impaired coordination and balance).

Core features of PSP include Parkinsonism (symmetrical slowness, stiffness, tremor), paralysis of upward gaze (difficulty looking upwards), dementia, personality change, and speech difficulties.

The main aims of Parkinson's Disease management are to educate and support the patient, preserve function, maintain general health and fitness, and treat other medical problems.

Non-pharmacological management of Parkinson's Disease involves various therapies and support measures such as support groups, physiotherapy and occupational therapy, dietary counseling, and communication with the patient's general practitioner.

Pharmacological management aims to replace dopamine deficiency and prevent its breakdown. This is achieved through various medications including dopamine precursors (levodopa), dopamine agonists (bromocriptine, pramipexole, etc.), MAOB inhibitors (selegiline, rasagiline), COMT inhibitors (entacapone), and anticholinergics (procyclidine, biperidin).