Overview
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- Diagnosis - when the diagnosis was made
- Manifestations - tremor, bradykinesia, rigidity, postural instability
- Management - dopamine replacement, MAO-B inhibitors, COMT inhibitors
Differential Diagnosis
Causes of Parkinsonism
- Parkinson's disease - Parkinsonism, anosmia, REM sleep behavioural disturbance, frontal executive dysfunction, depression
Parkinson's Plus Syndromes
- Progressive supranuclear palsy (PSP) - Parkinsonism with supranuclear downward gaze palsy (inability to look down)
- Multiple systems atrophy (MSA) - Parkinsonism, autonomic dysfunction, cerebellar involvement and pyramidal signs
- Dementia with Lewy Bodies (DLB) - Parkinsonism, visual hallucinations, fluctuating cognition
- Corticobasal degeneration (CBD) - rigidity, dystonia, focal myoclonus, ideomotor apraxia, alien limb syndrome
Others
- Drugs - antipsychotics, metoclopramide, lithium
- Normal pressure hydrocephalus
- Hypoxic brain injury
- Wilson's disease
Manifestations
Manifestations of Parkinson's Disease
Muscular
- Tremor
- Slowless of movement (bradykinesia)
- Dysarthria
- Muscular stiffness
- Hypophonia (quiet voice)
- Shuffling gait
- Gait freezing
- Micrographia
Non-Muscular
- Anosmia
- REM sleep behavioural disorder (acting out dreams)
- Autonomic dysfunction - constipation, postural hypotension, urinary hesitancy
- Depressive symptoms - low mood, anhedonia, fatigue
Management
Management Options for Parkinson's Disease
- Levodopa / decarboxylase inhibitor combos - levodopa / carbidopa, levodopa / benserazide
- Dopamine agonists - bromocriptine, pramipexole, rotigotine
- Monoamine oxidase-B inhibitors - rasagiline, selegiline
- Catecholo-methyltransferase (COMT) inhibitors - entecapone
- NMDA receptor antagonists - amantadine
- Anticholinergics - benztropine
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