PARKINSON'S DISEASE

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PARKINSON'S DISEASE MAKING THE DIAGNOSIS! A.C.
WILLIAMS
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MAKING THE DIAGNOSIS

• CAN BE EASY
• IF TYPICAL TREMOR
• RIGIDITY
• BRADYKINESIA
• POSTURE / GAIT
• IF GOOD RESPONSE TO TREATMENT
• LATER SIDE EFFECTS - DYSKINESIA

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CATCHES

• DRUG HISTORY NOT KNOWN
• 2. ESSENTIAL TREMOR
• 3. FESTINANT GAIT
• 4. NORMAL AGING
• 5. DEPRESSION

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TESTS
MRI
SCANS
SPECT
WHEN NECESSARY CLINICAL DIAGNOSIS STILL MOST
RELIABLE
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SPECT and ß-CIT progression
Baseline 15months 23months
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GENETIC P.D
DIRECTLY OR INDIRECTLY AFFECT MITOCHONDRIAL
(ENERGY) PACK FUNCTION AS DOES NON-GENETIC
PD. ALL AFFECT DOPAMINE RESPOND TO SAME
TREATMENT, EARLIER AGE OF ONSET TEST FOR IT ?
POINT FOR INDIVIDUAL ? IMPLICATIONS FOR
FAMILY
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PARKINSONISM v. PARKINSONS

• RARE WILSONS DISEASE ETC
• VASCULAR DISEASE
• PARKINSONS PLUS SYNDROMES
• A AUTONOMIC FAILIURE

AKA
BP
MSA
BLADDER
B EYE MOVMENTS / FALLS PSP C
DEMENTIA
CORTICAL LEWY BODY
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A CAVEAT THERE IS NO GOLD STANDARD. DISEASES
CAN CHANGE AND LABELS ARE PRAGMATIC FOR A
PRACTICAL USE. TUBERCULOSIS USED TO BE THOUGH
TOF AS 7 COMPLETLY DIFFERENT DISEASES WITH
GENETIC CAUSES.