3 “Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forward, and to pass from a walking to a running pace, the senses and intellects being uninjured.”
4 IntroductionParkinson’s disease is a chronic neurodegenerative movement disorder affecting voluntary and emotional movements and most commonly seen in the elderly, but is also found in the young and inexorably progresses leading to significant disability.
5 Epidemiology Primarily a disease of the elderly Mean age 55, Range yearsJuvenile parkinsonism- Less than 20 yearsM/F = 3:2Prevalence increases with age
6 Aging and Parkinson’s disease Exponential fallLinear fall
17 Classification and Etiology Medications that can cause parkinsonian symptoms, but not PD itself, include the following:MetoclopramideDomperidoneReserpine-containing antihypertensivesNeurolepticsSome evidence also indicates that certain environmental factors (including smoking and coffee drinking) may actually have protective associations.
18 Clinical features of Idiopatic Parkinson’s disease. Major featuresResting tremor in hands, arms, legs, jaw, and faceBradykinesiaRigidity- cogwheel or lead-pipeMinor featuresBradyphreniaSpeech abnormalitiesDepressionDysautonomiaDystoniaConstipationHallucinationsDysphagia
20 Parkinson’s disease -Symptomatology Tremor:RestFixed frequency 3-6 HzNot a feature of old agePill-rollingUsually starts in one limb, and then to other limbsRarely starts in lower limbsIntermittent for many yearsThey usually disappear briefly during movement and do not occur during sleep.Tremors can also eventually occur in the head, lips, tongue, and feet. In younger patients tremor is usually predominant and often suggests a less aggressive form of the disease.Tremor dominant
21 Parkinson’s disease-Symptomatology RigidityStriatal hand: Ulnar deviation, MCP flexion, IP extensionStriatal toe: Big toe dorsiflexionSitting en bloc: Collapses into a chair on attempting to sit down
22 Parkinson’s disease-Symptomatology PostureKyphosisFlexed elbows, knees and hipsHands held in front of bodyTrunk bent forwardHead bowed
23 Parkinson’s disease-Symptomatology BradykinesiaSlowness of motion (bradykinesia) is one of the classic symptoms of Parkinson's disease.Hypomimia- “masked facies”,expressionless face, blinkingSpeech abnormalities-Hypophonia: soft voiceAprosody of speech: monotonous and lack of inflectionTachyphemia: do not separate syllables together, running words togetherPatients may eventually develop a stooped posture and a slow, shuffling walk. The gait can be erratic and unsteady.
24 Parkinson’s disease-Symptomatology Motor fluctuationsFreezing phenomenon- Sudden, transient inability to perform active movements, lasting no more than a few secondsStart hesitationTurn hesitationTarget hesitationPalilalia (speaking)Apraxia of eyelid openingWritingKinesia paradoxica-Despite severe rigidity and bradykinesia, they may rise suddenly and move normally
25 Parkinson’s disease-Symptomatology “Today is a sunny day in Toronto"Loop drawing: Amplitude Interloop distance“Micrographia”
27 Movement Disorders Parkinson’s disease Hutington’s disease Multiple system atrophyMotor neuron diseaseCortical basal ganglionic degenerationPatients with PD may develop a stooped posture and a slow, shuffling walk. The gait can be erratic and unsteady.
30 DiagnosisThere are currently no blood or laboratory tests that have been proven to help in diagnosing PD. Therefore the diagnosis is based on medical history and a neurological examination. The disease can be difficult to diagnose accurately. Doctors may sometimes request imaging studies (i.e. MRI’s or brain scans) or laboratory tests in order to rule out other diseases.
31 Differential diagnosis of Parkinson’s diseases.
40 Predicted developments Research into the causes of Parkinson’s diseases are likely to show that multiple genetic and environmental factors are involvedDisease of early onset is more likely to be geneticNew drugs acting on both dopaminergic and non- dopaminergic transmitter systems will become available over the next 10 yearsClinical trials of new drugs with neuroprotective and neurorescue properties are in progress
41 ResearchAt no time in the past have the basic and clinical sciences applied to Parkinson’s disease been so active.Future progress in understanding the causation and pathogenesis of the disorder will permit the development of new treatments that will slow, halt, or even reverse the currently progressive course of Parkinson’s disease.