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What characterizes Stage 3 of Parkinson's Disease?
Which of the following is NOT a recognized type of parkinsonism?
Which drug is known to potentially cause drug-induced parkinsonism?
What is the earliest stage of Parkinson's Disease characterized by?
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Which type of degeneration is primarily linked to the symptoms of Parkinson's Disease?
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What primary feature is characterized by difficulty initiating movement and reduced spontaneous activity?
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Which term describes the type of rigidity where opposing limbs exhibit increased tone during movement?
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Which of the following best describes 'resting tremor' typically seen in Parkinsonism?
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What is one common postural change observed in individuals with Parkinsonism?
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What leads to increased activity of neurons in the subthalamic nucleus in Parkinsonism?
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Which of the following differentiation between rigidity and spasticity is accurate?
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Which symptom is NOT commonly associated with Parkinsonism?
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What clinical feature is characterized by a soft voice and difficulty with gestures in patients with Parkinsonism?
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What is the significance of James Parkinson in relation to Parkinson's Disease?
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Which of the following is NOT considered a type of parkinsonism?
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Which theory is associated with a potential reduced prevalence of idiopathic Parkinson's Disease (IPD)?
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Which structures of the brain are primarily associated with voluntary motor control and learning?
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What is currently known about the aetiology of Idiopathic Parkinson's Disease?
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Study Notes
Defining IPD
- IPD stands for Idiopathic Parkinson's Disease
- Named after James Parkinson, who published 'An Essay on the Shaking Palsy' in 1817
- Parkinson's disease is recognized as a medical condition due to his work
- IPD is a progressive neurological condition characterized by slowness of movement, rigidity, tremor, and postural instability
Aetiology
- The cause of IPD is unknown
- Several theories exist about its cause
- Nicotine - IPD is less prevalent in smokers than lifelong abstainers
- MPTP - caused severe parkinsonism in young drug abusers
- Genetic factors - clustering of early-onset PD in some families
Pathology
- The basal ganglia is a group of nuclei in the brain situated at the base of the forebrain
- The basal ganglia is associated with voluntary motor control, procedural learning, eye movements, cognitive and emotional functions
- The basal ganglia consists of the striatum, globus pallidus, substantia nigra (SN), nucleus accumbens and subthalamic nucleus
- Depletion of pigmented dopaminergic neurons in SN
- Reduced dopaminergic output from SN
- Inclusion bodies (Lewy bodies) develop in nigral cells
- Degeneration in other basal ganglia nuclei
- Neurons in the subthalamic nucleus become more active than usual, inhibiting activation of the cortex
Clinical Features
- Bradykinesia (slow and small movements)
- Postural instability
- Rigidity
- Resting Tremor
Parkinsonism
- Comprises four cardinal motor features
- Bradykinesia (slow and small movements)
- Reduced blink, face expression, and gesturing
- Soft voice
- Difficulty getting out of a chair, shuffling steps, reduced arm swing, freezing
- Tremor (usually resting) “pill rolling”. Often involves the thumb
- Rigidity (different from spasticity)
- Postural changes. Imbalance, falls; stooped flexed posture
Stages of PD
- Stage 0: No signs of disease
- Stage 1: Unilateral disease
- Stage 1.5: Unilateral disease plus axial involvement
- Stage 2: Bilateral disease, without impaired balance
- Stage 2.5: Bilateral disease, with impaired balance
- Stage 3: Mild to moderate bilateral disease, some postural instability; physically dependent
- Stage 4: Severe disability; still able to walk or stand unassisted
- Stage 5: Wheelchair-bound or bedridden
Differential Diagnosis of Parkinsonism
- Parkinson disease (idiopathic or genetic)
- Parkinson-plus degenerations (dementia with Lewy bodies, progressive supranuclear palsy, corticobasal degeneration, multiple system atrophy)
- Drug-induced parkinsonism (anti-dopaminergics)
- Rare but treatable in young people - Wilson disease and Dopa-responsive dystonia
- Other - “vascular” parkinsonism, brain trauma, CNS infection
Drug-Induced Parkinsonism
- Drugs that reduce dopamine transmission
- Antipsychotics / antiemetics: Risperidone, haloperidol, metoclopramide, promethazine, prochlorperazine etc.
- Can be indistinguishable from PD
- Clozapine does not seem to cause it, quetiapine appears to have low rates
- Management: Reduce or discontinue offending agent, can take months to resolve!
Parkinson Disease (PD)
- Usually idiopathic
- Substantia nigra degeneration causes dopamine deficiency in striatum motor symptoms
- Dopaminergic therapy relieves motor symptoms
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Description
This quiz explores Idiopathic Parkinson's Disease (IPD), its aetiology, and pathology. You will learn about the historical context of IPD, factors contributing to its development, and the neurological implications it holds. Test your knowledge on this progressive condition and its effects on the brain.
