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Parkinson’s Disease
superKAT :)
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Parkinsonism
• Neurological syndrome• Combination of:– Rest tremors– Rigidity – Bradykinesia
• 77% PD• 12% Parkinson plus syndromes• 5% Drug induced Parkinsonism*not recognized early
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• Primary/idiopathic parkinsonism– Parkinson’s disease– Juvenille parkinsonism
• Secondary – Infectious, drugs, toxins, vascular, trauma
• Heredodgenerative parkinsonism– Huntington’s – Wilson
• Multiple-system degeneration/ parkinsonism-plus– CBD– LBD– Multisystem atrophy– PSP
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Definition – Parkinson’s
• Described by James Parkinson in 1817 as the “shaking palsy”
• Chronic progressive disorder occurring in the Central Nervous System
• Results from degeneration of dopamine-producing cells in the susbtantia nigra (pars compacta – degenerate more and pars reticularis)
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• 2nd most common neurodegenerative disease after Alzheimer’s disease
• Age-related, progressive disorder• Dopamine, critical modulator of striatal
output, is markedly decreased PD = control fine skillful movements
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Prevalence
• PD is estimated to affect 100-180 in 100,000• Annual incidence of 4-20 per 100,000• Rising prevalence with age• Male: Female ratio is 3:2
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Pathogenesis
• Neurogenerative• Loss of dopaminergic input to basal ganglia
(extrapyramidyal system)• Result in imbalance with dopamine and
acetylcholine
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Etiology
• Unknown• Oxidative stress• Proposed etiology– Aging– Environmental toxins– Genetic susceptibility
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Oxidative stress theory
• Increased iron level• Lack of compensatory rise in isoferritins• Increased aluminum levels• Reduced glutathione levels• Selective defect in complex I of mitochondrial
respiratory chain• Evidence of oxidative damage to– Lipids, DNA, proteins, tyrosine-containing
molecules
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• Oxidative stress• Mitochondrial dysfu• Excitotoxicity• abnorma
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genetics
• Young onset <40yrs• Juvenile onset <20yrs • Parkin mutations: parkin gene• Mutations in the alpha synuclein and ubiquitin
carboxy hydrolase: seen in autosomal dominant PD
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Pathology
• Loss of dopaminergic (DA) cells located in susbtantia nigra: most symptoms do not appear striata DA levels decline by at least 70-80%
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Pathophysiology
• Degeneration of substantia nigra• Reduced production of dopamine
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Clinical Manifestations
• Bradykinesia – bumabagal• Tremor• Rigidity *Stooped posture
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Symptoms
• T- Tremors at rest• R- Rigidity• A- Akinesia/Bradykinesia • P- Postural instability
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Tremors
• 4-6Hz• Resting• Disappears with voluntary movement• Disappears with sleep• Accentuated by stress/anxiety• Pill rolling
*Essential tremor & Physiology tremors 8-12 Hz and are kinetic and/or postural
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Limb rigidity
• Resistance to passive movements of limbs• Involuntary hypertonia• Cogwheel
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Bradykenisa
• Decreased speed and amplitude of complex voluntary movements
• Slowness and initiating and sustaining movement• Fragmented• Micrographia – lack of movement of the
arm/difficulty• Tapping fingers• Twiddling
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Postural instability
• Stooped, nanginginig ang kamay• Shuffling gait • Righting reflex• equilibrium