This is a lecture on the Basic information on Parkinson's Disease. There is also a Video that I have prepared based on this presentation on You Tube Channel - KNOLEAD www.knolead.com

1. Dr Sweta Singla
MD / DM Neurology
Understanding

2. Why do we need to
understand About
Parkinson’s Disease
WHO Global Estimates : More than 8.5 million people worldwide are
living with PD.
The Prevalence of PD has doubled
in the past 25 years

3. Elderly Indians has increased from 5.6% (51 million) in 1961 to
7.1% (71million) in 2001.
0.
2.
4.
6.
8.
1961 2001

4. Parkinson’s disease is the commonest
movement disorder ( 24 % )
24%
76%
3-8 % of Neurological disorders
• 20 % of neurology admissions
• 33 % of residents of old age
home
Movement Disorders

5. Affects Quality of Life of Patients and Care givers
Informal carers (i.e. most commonly family members and
friends) spend many hours daily providing care for people
living with PD. This can be overwhelming. Physical, emotional
and financial pressures can cause great stress to families and
carers, and support is required from the health, social,
financial and legal systems.

6. What are
the
symptoms
of
Parkinson’
s Disease
?

7. Premotor Prodrome Phase
❖ Constipation / Flatulence
❖ Anosmia
❖ Mood Disorder
❖ Low Blood Pressure ?

8. Motor Symptoms
Image Courtesy : https://parkinsonsnebraska.org/understanding-parkinsons-disease/

10. Non Motor Symptoms
SLEEP DISORDER
COGNITIVE DECLINE /HALLUCINATIONS
MOOD DISORDER
AUTONOMIC DYSFUNCTION
PAIN / DYSAESTHESIA
GENITO -URINARY PROBLEMS

12. , Mingchun & Zhang, Yuan & Xu, Wenyao. (2020). mHealth Technologies Towards Parkinson's Disease Detection and Monitoring in Daily Life: A Comprehensive Review. IEEE Re

13. What causes Parkinson’s Disease
?
Environment Life Style
Genetics

14. Famous
Personalities
with PD
MOHAMMAD ALI - BOXER
ROBIN WILLIAMS - ACTOR
MICHEAL J FOX - ACTOR
POPE JOHN PAUL II

15. PD and PD Plus
❖ Not All patient who are Slow are Parkinson’s Disease
❖ MIMICS of PD : PD Plus syndromes
❖ Progressive Supranuclear Palsy
❖ Secondary Parkinsonism
❖ Multi System Atrophy
❖ Cortico Basal Ganglionic Degeneration
❖ Essential Tremors
❖ Other Diseases where there might be confusion : Depression /
Balance disorders / Arthritis / Hypothyroidism

16. Myths
❖ Genetic Myths - Parkinson’s Disease is heritable - only 4 % of
PD patients are familial
❖ All tremors are PD
❖ No tt for PD
❖ Terminal illness
❖ PD patients should stop working
❖ PD patients can not live independently
❖ PD Patients can not live productive life

17. Myths
❖ PD patient has memory loss
❖ Treating doctors can predict the future
❖ Relationship with other diseases : If Person has PD
explains every other symptoms
❖ PD is not responsible for every problem

18. Points to be noted
❖ PD can not be permanently cured
❖ Management should be started as soon as possible
❖ Dopamine cannot improve all the symptoms
❖ Levodopa Phobia should be avoided - It is a tool for us
- ? should be delayed / dangerous / damages brain
❖ Levo Dopa - only works for few years ?

19. Do not get trapped !
❖ Should defer next dose of LD
❖ Stem cell - no definitive evidence
❖ Apomorphine video - faster action / but injectable /
expensive
❖ Physiotherapy / Physical activity - should always be
done

20. Myths about Sx
❖ DBS - cure / Dangerous
❖ Misinformation
❖ Creating awareness about the PD
❖ Education patient/ care givers / Employers need to be
Educated About PD
❖ Team Work Should be emphasised

21. Clinical presentation
❖ C/P : Symptom recognition / Classifying
❖ Varied / complex / spectrum
❖ no biomarker
❖ correct classification

22. PD symptoms
❖ Complex
❖ Variale
❖ Pattern / phenomenology
❖ Diagnosis may need review after sometime

23. Akinesia /Bradykinesia
❖ Amplitude and speed
❖ Progressive reduction in the amplitude and speed at different joints
❖ 64 movement or repetitions
❖ micrographia
❖ D/D :
❖ Depression - hypomimia ;
❖ Dystonia may lead to decreased arm swing
❖ Gait problems - also seen in arthritis

24. Tremors
❖ Resting / pill rolling / Remergent termors
❖ D/D : Essential tremors - make a spiral
❖ Drug induced tremors - Hyperthyroid / Beta Agonists -
Asthma Medicines

25. Subtypes of Parkinson’s
Disease
❖ Tremor Predominant
❖ Postural Instability Gait Disorder
❖ PDD - Parkinson’s Disease with Dementia
❖ PD with prominent Non Motor Symptoms

26. Rule out Secondary
parkinsonism
❖ Ataxia - MSA
❖ Vertical gaze - PSP
❖ Cortical sensory loss Grpahesthesia / sterognosis /
ideomotor apraxia / prog aphasia
❖ LL Parkinsoniam
❖ Poor Dopa Response
❖ H/o Dopa rc Blocker

27. Red Flags
❖ Rapid Progression to wheel chair in 5 yr
❖ Early autonomic failure in 5
❖ Early bulbar function in 5 yr
❖ Symm parkinsonism
❖ Absence of non motor symptoms
❖ Pyramidal signs
❖ Early and Reccurent falls
❖ Retrocollis - Trunk bent backwards

28. DIAGNOSIS
CLINICAL
PRESENTATION -
a Neurologist
Examining you FUNCTIONAL SCANS :
TRODAT Scan
FLUORO DOPA SCAN IN PD
CT / MRI Brain - Limited Role

29. Management
❖ Non Pharmacological
❖ Pharmacological : Medicines that work on Dopamine
Pathway
❖ Surgery - DBS - Deep Brain Stimulation
❖ Stem Cell/ Gene Therapy - not an option as of now

30. Take Aways
❖ Learn to look for Symptoms of Parkinson’s Disease
around you
❖ Send the patient to a Neurologist so that Diagnosis is
confirmed
❖ Management should be started as soon as possible
❖ Surgery is option is selected cases
❖ Physical Activity should be emphasised in all cases

31. It is Your Life !
&
You need to make sure,
You live it to the full…