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Parkinson’s Disease (Examination (Extras (Glabellar tap, Gait Slow…

- - - - Drug chart
        
        Abdominal examination: hepatomegaly + signs of CLD
- - - - Assess disability
        e.g. UPDRS: Unified Parkinson’s Disease Rating Scale
        
        Physiotherapy: postural exercises
        
        Depression screening
- - - - Caeruloplasmin: ↓ in Wilson’s
    - - CT / MRI: exclude vascular cause
      - DaTscan
        
        Ioflupane I123 injection
        
        Binds to dopaminergic neurones and allows
        visualisation of substantial nigra
        
        Can exclude other causes of tremor: e.g. BET
- - - - β-amyloid plaques
        
        Neurofibrillary tangles: hyperphosphorlated tau
  - - - Sleep Disorder
        
        Affects ~90% of PD pts.
        
        Insomnia + frequent waking → EDS
        
        Inability to turn
        
        Restless legs
        
        Early morning dystonia (drugs wearing off)
        
        Nocturia
        
        OSA
        
        REM Behavioural sleep Disorder
        
        Loss of muscle atonia during REM sleep
        
        Violent enactment of dreams
        
        Da SEs: insomnia, drowsiness, EDS
  - - - End-of-dose
        
        deterioration as dose wears off w/ progressively shorter benefit.
      - On-Off effect
        
        unpredictable fluctuations in motor performance unrelated to timing of dose.
- - - - Papp-Lantos Bodies: α-synuclein inclusions in glial cells
    - - Autonomic dysfunction: postural hypotension
        
        Parkinsonism
        
        Cerebellar ataxia
  - - - α-synuclein and ubitquitin Lewy Bodies in brainstem and neocortex