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 was developed by Shen-Yang Lim, Neurologist and Professor at the University of Malaya, Kuala Lumpur, Malaysia, in collaboration with Cambridge (a division of Prime, Cambridge, UK).

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slide deck

Introduction

History, definitions and diagnosis
History, definitions and diagnosis

Parkinson’s disease is a chronic, progressive, neurodegenerative condition, mainly affecting the elderly.1

Reference:
1. 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

The history of Parkinson’s disease
The history of Parkinson’s disease
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The ‘shaking palsy’
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.2,3

In his historic essay, Parkinson drew together his observations of several patients who were affected by similar …

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Parkinson’s disease
Parkinson’s disease

In 1872, Jean-Martin Charcot identified general slowness of movement (‘bradykinesia’) as a prominent feature of paralysis agitans.1 Bradykinesia is now known as one of the characteristic, or ‘cardinal’, features of PD.1 Charcot also distinguished between the tremors cause…

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The dopamine deficiency hypothesis
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).6,7 This ‘dopamine deficiency’ appeared to be caused by a marked…

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Lewy bodies
Lewy bodies

Lewy bodies are mostly comprised of abnormal, misfolded protein, and are found in the nerve cells of most patients with PD.1,5 The function of Lewy bodies in the pathogenesis of PD is still unclear, as they have been associated with both neuroprotection and toxicity.6 It …

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α-synuclein
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.7 The precise function of α-synuclein has been difficult to determine, but it appears to interact with and affect various proteins at the sy…

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The cardinal features of Parkinson’s disease

The cardinal features of Parkinson’s disease
The cardinal features of Parkinson’s disease
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Parkinsonism
Parkinsonism

‘Parkinsonism’ is a collection of four clinical features that are typically, although not exclusively, observed in PD.2 The features may also be present in patients with other neurological disorders, including progressive supranuclear palsy, multiple system atrophy, corti…

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Motor symptoms – bradykinesia
Motor symptoms – bradykinesia

Bradykinesia refers to a slowness of movement.1 Patients with PD often report feeling clumsy or slow, and this may be misinterpreted by family members as a ‘normal’ part of ageing.6 Bradykinesia can manifest in different ways, but it always appears at some point during PD…

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Motor symptoms – muscular rigidity
Motor symptoms – muscular rigidity

The muscular rigidity or stiffness associated with parkinsonism – sometimes called ‘extrapyramidal rigidity’ – is a key feature of the syndrome.2,3 During the earlier stages of PD, rigidity may manifest solely as pain and can be easily misinterpreted as a musculoskeletal …

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Motor symptoms – resting tremor
Motor symptoms – resting tremor

Tremors are a common and highly-visible symptom of PD, typically present when the patient is fully at rest.5 The shaking action tends to be a rhythmic, medium-frequency oscillation.1 It starts when the particular body part is relaxed and supported by a surface, disappears…

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Motor symptoms – postural instability
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.3 Since this integration is necessary to maintain balance during movement, the loss o…

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Motor symptoms – gait impairment
Motor symptoms – gait impairment

Postural instability and gait impairments are universally features of advanced PD.1,4 Examination of gait in patients with PD involves asking the patient to stand, unaided, from a seated position, then walk approximately ten metres, turn around, walk back, and sit down ag…

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The non-motor symptom complex of Parkinson’s disease
The non-motor symptom complex of Parkinson’s disease

PD has traditionally been regarded as a motor disorder.3 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.3

Many non-motor symptoms, for exampl…

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Clinical symptoms and time course of Parkinson’s disease progression
Clinical symptoms and time course of Parkinson’s disease progression

The development of PD is generally slow and progressive.1 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.3 This prodromal phase is typically characterised by a range of non-motor symptoms…

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Trajectories of neurodegeneration in body- and brain-first subtypes of Lewy body disease

In brain-first patients (bottom panel), the dopamine system starts to degenerate early

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image Image Characteristics of proposed body-first and brain-first subtypes of PD. Arrows indicate the direction of spread of α-synuclein pathology. In body-first Parkinson disease (left), the first α-synuclein aggregation occurs in the gut and propagates through the sympathetic nervous system to the sympathetic trunk and heart, and via the vagus nerve to the brainstem. Autonomic dysfunction and REM sleep behaviour disorder (RBD) are prodromal features. In brain-first PD (right), the initial α-synuclein pathology enters via the olfactory bulb (OB) and spreads to the amygdala and nigrostriatal dopamine system. The pathology then descends through the brainstem and RBD and dysautonomia generally develop after the onset of parkinsonism. During the later disease stages, nearly all patients have widespread pathology in these systems and their symptomatology therefore converges.
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Characteristics of proposed body-first and brain-first subtypes of Parkinson’s disease

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The Trajectory of Brain-first and Body-first PD

The body-first and brain-first model suggests that the clinical subtype with mild or no “bodily symptoms” before diagnosis reflects a brain-first origin of the disease

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