Understanding Idiopathic Parkinson's Disease

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Questions and Answers

What characterizes Stage 3 of Parkinson's Disease?

Unilateral disease plus axial involvement

Mild to moderate bilateral disease with some postural instability (correct)

Wheelchair-bound or bedridden

No signs of disease

Which of the following is NOT a recognized type of parkinsonism?

Corticobasal degeneration

Idiopathic Parkinson disease

Familial tremor syndrome (correct)

Multiple system atrophy

Which drug is known to potentially cause drug-induced parkinsonism?

Quetiapine

Risperidone (correct)

Seroquel

Clozapine

What is the earliest stage of Parkinson's Disease characterized by?

Unilateral disease only Signup and view all the answers

Which type of degeneration is primarily linked to the symptoms of Parkinson's Disease?

Substantia nigra degeneration Signup and view all the answers

What primary feature is characterized by difficulty initiating movement and reduced spontaneous activity?

Bradykinesia Signup and view all the answers

Which term describes the type of rigidity where opposing limbs exhibit increased tone during movement?

Cogwheel rigidity Signup and view all the answers

Which of the following best describes 'resting tremor' typically seen in Parkinsonism?

Tremor that typically resembles 'pill rolling' of the thumb Signup and view all the answers

What is one common postural change observed in individuals with Parkinsonism?

Flexed posture Signup and view all the answers

What leads to increased activity of neurons in the subthalamic nucleus in Parkinsonism?

Depletion of pigmented dopaminergic neurons Signup and view all the answers

Which of the following differentiation between rigidity and spasticity is accurate?

Rigidity is constant regardless of movement, spasticity changes with movement Signup and view all the answers

Which symptom is NOT commonly associated with Parkinsonism?

High-energy movements Signup and view all the answers

What clinical feature is characterized by a soft voice and difficulty with gestures in patients with Parkinsonism?

Bradykinesia Signup and view all the answers

What is the significance of James Parkinson in relation to Parkinson's Disease?

He published an influential essay that recognized Parkinson's as a medical condition. Signup and view all the answers

Which of the following is NOT considered a type of parkinsonism?

Neuroleptic drug syndrome Signup and view all the answers

Which theory is associated with a potential reduced prevalence of idiopathic Parkinson's Disease (IPD)?

Nicotine use appears to be associated with lower prevalence in smokers. Signup and view all the answers

Which structures of the brain are primarily associated with voluntary motor control and learning?

Basal ganglia, including the substantia nigra and striatum Signup and view all the answers

What is currently known about the aetiology of Idiopathic Parkinson's Disease?

The exact aetiology is unknown with several hypotheses. Signup and view all the answers

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.