(Medicine of Elderly) (GP)

Overview

• Degeneration of dopaminergic neurons in the basal ganglia, particularly the substantia nigra
• M>F (2:1), mean age of onset ∼65 years old
• Risk Factors → genetic, environmental factors, MPTP exposure (drug that damages the substantia nigra), drug-induced (anti-psychotics)
• Parkinsonism
  • Drug Induced ⇒ anti-psychotics (eg. haloperidol), typically bilateral
  • Lewy Body Dementia ⇒ memory loss, visual hallucinations and parkinsonism
  • Progressive Supranuclear Palsy ⇒ postural instability (falls), impaired vertical gaze, cognitive impairment, parkinsonism
  • Multisystem Atrophy ⇒ autonomic features such as postural hypotension, incontinence and impotence

Making Diagnosis

Clinical Features:

• Bradykinesia → slowness of movements, shuffling gait
• Resting Tremor → asymmetrical onset, improves with voluntary movement. Typically ‘pill-rolling’ (thumb and index finger). 3-5 Hz.
• Rigidity → lead pipe, cogwheel
• Postural Instability → imbalance or falling observed. Shuffling gait.

(TRAP → tremor, rigidity, akinesia, postural instability)

• Other Symptoms → Fatigue, Constipation, Depression, Anxiety, Insomnia, Hypomimia

Progressive Supranuclear Palsy ⇒ postural instability + falls, impaired vertical gaze (difficulty reading or descending stairs), parkinsonism, poor response to L-dopa.