Progressive neurodegeneration of dopaminergic substantia nigra neurons → bradykinesia, rigidity, resting tremor, postural instability.
Clinical features
- • Asymmetric resting tremor 4–6 Hz
- • Bradykinesia, micrographia
- • Cogwheel rigidity
- • Hypomimia, hyposmia, REM sleep behaviour disorder (prodrome)
- • Non-motor: constipation, depression, dementia
Investigations
- • Clinical diagnosis (UK Brain Bank criteria)
- • DAT scan if atypical features
Management
- • Levodopa-carbidopa (most effective; reserve in young to delay dyskinesia)
- • Dopamine agonists (ropinirole, pramipexole)
- • MAO-B inhibitors (rasagiline)
- • Advanced: apomorphine, DBS, levodopa-carbidopa intestinal gel
Complications
- • Motor fluctuations / dyskinesia
- • Falls, dementia, psychosis
- • Autonomic dysfunction
References
- • NICE NG71 Parkinson 2017
Related in WardRound
Educational — verify locally.
