Parkinsons Disease – History, Definitions and Diagnosis

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Slide description

Parkinson’s disease is a chronic, progressive, neurodegenerative condition, mainly affecting the elderly.^{[Lees et al., 2009]}

Reference:
Lees AJ, Hardy J, Revesz T. Parkinson’s disease. Lancet 2009; 373 (9680): 2055–2066.

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Parkinson’s Disease (PD) is a chronic, progressive, neurodegenerative condition that mainly affects elderly people. In this slide deck, basic PD concepts and definitions are explored. It includes infographics on the cardinal symptoms, diagnostic criteria, PD biomarkers and commonly used scales in PD research.

This slide deck has been developed in collaboration with the former Lundbeck International Neuroscience Foundation.

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Parkinsons Disease – History Definitions and Diagnosis – slide 1

History, definitions and diagnosis

Parkinson’s disease is a chronic, progressive, neurodegenerative condition, mainly affecting the elderly.^{[Lees et al., 2009]}

Reference: Lees AJ, Hardy J, Revesz T. Parkinson’s disease. Lancet 2009; 373 (9680): 2055–2066.

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The history of Parkinson’s disease

Parkinsons Disease – History Definitions and Diagnosis – slide 2

The history of Parkinson’s disease

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The ‘shaking palsy’

The condition that we now know as Parkinson’s disease (PD) was first described systematically in 1817 by the London surgeon and apothecary James Parkinson.^{[Lees et al., 2009; Pfeiffer et al., 2013]}

In his historic essay, Parkinson drew together…

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Parkinsons Disease – History Definitions and Diagnosis – slide 4

Parkinson’s disease

In 1872, Jean-Martin Charcot identified general slowness of movement (‘bradykinesia’) as a prominent feature of paralysis agitans.^{[Goetz, 2011]} Bradykinesia is now known as one of the characteristic, or ‘cardinal’, features of PD.^{[Goetz, 2011]} Charcot also distinguished between the tremors…

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Parkinsons Disease – History Definitions and Diagnosis – slide 5

The dopamine deficiency hypothesis

In 1960, scientists showed that brains of PD patients had very low levels of the neurotransmitter dopamine, particularly in the region known as the striatum (comprised of the putamen and the caudate nucleus).^{[LeWitt & Fahn, 2016; Ehringer & Hornykiewicz,…}

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Parkinsons Disease – History Definitions and Diagnosis – slide 6

Lewy bodies

Lewy bodies are mostly comprised of abnormal, misfolded protein, and are found in the nerve cells of most patients with PD.^{[Lees et al., 2009; Ropper et al., 2014]} They were first discovered by Fritz Heinrich Lewy in 1912, although…

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Parkinsons Disease – History Definitions and Diagnosis – slide 7

α-synuclein

Since its discovery in the 1990s, the dysfunction of the protein α-synuclein has emerged as a major factor in the development of PD.^{[Burré, 2015]}

The precise function of α-synuclein has been difficult to determine, but it appears to interact…

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The cardinal symptoms of Parkinson’s disease

Parkinsons Disease – History Definitions and Diagnosis – slide 8

The cardinal symptoms of Parkinson’s disease

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Parkinsons Disease – History Definitions and Diagnosis – slide 9

Parkinsonism

‘Parkinsonism’ is a collection of four clinical features that are typically, although not exclusively, observed in PD.^{[Massano & Bhatia, 2012]} The features may also be present in patients with other neurological disorders, including progressive supranuclear palsy, multiple system atrophy,…

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Parkinsons Disease – History Definitions and Diagnosis – slide 10

Motor symptoms – bradykinesia

Bradykinesia refers to a slowness of movement.^{[Pfeiffer et al., 2013]} Patients with PD often report feeling clumsy or slow, and this may be misinterpreted by family members as a ‘normal’ part of ageing.^{[Williams & Litvan, 2013]} Bradykinesia can manifest in…

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Parkinsons Disease – History Definitions and Diagnosis – slide 11

Motor symptoms – muscular rigidity

The muscular rigidity or stiffness associated with parkinsonism – sometimes called ‘extrapyramidal rigidity’ – is a key feature of the syndrome.^{[Massano & Bhatia, 2012; Williams & Litvan, 2013]}

During the earlier stages of PD, rigidity may manifest solely as…

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Parkinsons Disease – History Definitions and Diagnosis – slide 12

Motor symptoms – resting tremor

Tremors are a common and highly-visible symptom of PD, typically present when the patient is fully at rest.^{[DeMaagd & Philip, 2015]} The shaking action tends to be a rhythmic, medium-frequency oscillation.^{[Massano & Bhatia, 2012]} It starts when the particular…

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Parkinsons Disease – History Definitions and Diagnosis – slide 13

Motor symptoms – postural instability

During the progression of PD, the postural reflexes become increasingly impaired as the brain struggles to integrate sensory information about the relative position of various body parts.^{[Rinalduzzi et al., 2015]} Since this integration is necessary to maintain balance during movement,…

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Parkinsons Disease – History Definitions and Diagnosis – slide 14

Motor symptoms – gait impairment

Postural instability and gait impairments are universally features of advanced PD.^{[Massano & Bhatia, 2012; Williams & Litvan, 2013]} Examination of gait in patients with PD involves asking the patient to stand, unaided, from a seated position, then walk approximately…

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Parkinsons Disease – History Definitions and Diagnosis – slide 15

The non-motor symptom complex of Parkinson’s disease

PD has traditionally been regarded as a motor disorder.^{[Massano & Bhatia, 2012]} However, physicians are increasingly realising the need to recognise non-motor symptoms, both for diagnostic and management purposes, to try to improve patients’ quality of life.^{[Massano & Bhatia,…}

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Parkinsons Disease – History Definitions and Diagnosis – slide 16

Clinical symptoms and time course of Parkinson’s disease progression

The development of PD is generally slow and progressive.^{[Kalia & Lang, 2015]} While diagnosis tends to occur with the onset of motor symptoms, this can be preceded by a long prodromal phase of 15 years or more.^{[Goldman & Postuma,…}

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