Parkinson disease

1. PARKINSONISM
PRESENTED BY:
NOUMAN MUSHTAQ

2. OVER-VIEW
• Parkinson’s disease (PD) is a brain disease that affects movement and
coordination. Neurons (nerve cells) in a part of the brain called the substantia
nigra die. This leads to a loss of muscle control.
• Other conditions share certain PD symptoms, but have different causes. These
conditions are called atypical Parkinsonism or atypical Parkinsonian syndromes.

3. TYPES OF PARKINSONISM
• Atypical Parkinsonism includes several conditions similar to PD. Among them
are:
• Lewy body dementia (LBD)
• multiple system atrophy (MSA)
• progressive supranuclear palsy (PSP)
• corticobasal degeneration (CBD)

4. EPIDEMIOLOGY
• Each of these atypical Parkinsonian syndromes occur in less than
• LBD: 400 cases per 100,000 people
• MSA: 5 to 10 cases per 100,000 people
• PSP: 5 to 10 cases per 100,000 people
• CBD: 1 case 100,000 people

5. SYMPTOMS
• PD symptoms vary from person to person. Some people have a tremor, usually
on one side of the body. Others with PD have muscle freezing or balance
difficulties.
• You might have PD symptoms that are mild for years. Someone else may have
symptoms that worsen quickly.

6. SYMPTOMS
• A typical Parkinsonian syndromes each have their own set of symptoms:
• LBD: Thinking and memory decline. Hallucinations and difficulty staying alert are
signs that usually show up early.
• MSA: Walking and balance problems are especially common with this condition.
You may also have symptoms related to the autonomic nervous system
(ANS),which is the part of the nervous system that controls functions like
digestion and circulation. These include:
• constipation
• incontinence
• a sudden drop in blood pressure when you stand up (orthostatic hypotension)

7. • PSP: Problems with walking and balance, eye movement, speech, and thinking
skills are among the main symptoms of this disorder.
• CBD: The main symptoms of this condition include slow movements, difficulty
with spontaneous movements, muscle rigidity, severe tremors, and abnormal
posture or positioning of your limbs

8. • PD vs. atypical Parkinsonism
• Symptoms of PD and atypical Parkinsonism are sometimes identical. This is why
testing and imaging are so important in making an accurate diagnosis. Atypical
• Parkinsonism is sometimes diagnosed initially as PD.
• One of the main differences between the two conditions is that atypical
Parkinsonism symptoms tend to come on earlier than with PD. Problems with
balance,
• muscle freezing, thinking skills, speech, and swallowing show up sooner. They
also progress faster if you have atypical Parkinsonism.

9. • PD symptoms often appear first on one side of the body. With atypical
Parkinsonism, signs are usually present on both sides at the beginning.
• Another key difference between PD and atypical Parkinsonism is what’s
happening in the brain. If you have PD, you lose neurons that make the brain
chemical dopamine. It helps control movement. However, your brain still has
dopamine receptors. Those receptors allow the drug levodopa (Sinemet) to be
synthesized into dopamine.

10. • Certain brain changes define each condition:
• LBD: An unusual buildup of alpha-synuclein protein in brain cells.
• PSP: A buildup of tau protein in the brain’s frontal lobe, cerebellum, substantia
nigra, and brain stem.
• MSA: An abnormal buildup of alpha-synuclein protein that can affect the
substantia nigra, cerebellum, and ANS.
• CBD: A tau protein buildup that usually affects one side of the body and makes
movement difficult.

11. DIAGNOSIS
• Diagnosing atypical Parkinsonism starts with a review of all your symptoms and
your medical history.
• A neurological exam will also be part of the evaluation. Your doctor might
observe you walking across the room, sitting down, standing up, and
performing
• other basic movements. They’ll look for problems with balance and
coordination. Your doctor may also do some simple tests of your arm and leg
strength.
• You may take some tests of your mental ability, such as repeating back lists of
numbers or answering questions about current events.

12. • Your doctor may order imaging tests of the brain. Some commonly used tests
include:
• Positron emission tomography (PET) scan:
• A radioactive dye called a tracer reveals signs of disease or injury to the brain.
• Magnetic resonance imaging (MRI) scan:
• A magnetic field and radio waves create images of the inside of your body.
• DAT-SPECT: A type of computed tomography (CT) scan checks the movement of
dopamine in the brain.

13. TREATMENT
• No cures currently exist for atypical Parkinsonism. The goal of treatment is to
manage symptoms for as long as possible. The appropriate medication for
• each disorder depends on your symptoms and how you respond to treatment.
• For LBD, some people find relief from symptoms with
• cholinesterase inhibitors.
• These drugs increase the activity of neurotransmitters that affect memory and
judgment.
• For PSP, levodopa and similar drugs that act like dopamine are helpful for some
people.

14. • Participating in physical or occupational therapy can also help with most of these
conditions.
• Being physically active may also help relieve symptoms.
• Carbidopa-levodopa
• Carbidopa-levodopa infusion
• Dopamine agonists
• MAO B inhibitors.
• Catechol O-methyltransferase (COMT) inhibitors.
• Tolcapone (Tasmar)
• Anticholinergics.
• Amantadine

15. POSSIBLE COMPLICATIONS
• Perhaps the most serious complication from any of these conditions is dementia.
• You may first develop mild cognitive impairment (MCI), which may not interfere
too much with your daily activities. If your thinking skills and memory gradually
decline, you may need the assistance of family, a home health aide, or an assisted
living facility.
• Because these conditions affect balance and coordination, fall risk becomes an
important concern. Having PD or atypical Parkinsonism means avoiding falls and
fractures. Make your home safer by getting rid of throw rugs, lighting hallways at
night, and installing grab bars in the bathroom

16. REFEERENCES
• https://www.healthline.com/health/atypical-parkinsonism#pd-vs-atypical-
parkinsonism
• https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-
treatment/drc-20376062