Parkinson Disease

Parkinson Disease is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Parkinson disease (PD) is a progressive neurodegenerative disorder caused by degeneration of dopaminergic neurons in the substantia nigra pars compacta.
  • Cardinal symptoms include resting tremor, rigidity, bradykinesia, and postural instability.
  • Diagnosis is based primarily on history and examination.

Epidemiology

Incidence
  • Average age of onset: ~60 years
  • Slightly more common in men than women

Prevalence
  • Second most common neurodegenerative disease after Alzheimer disease
  • 0.3% of general population and 1–2% of those ≥60 years of age and up to 4% of those ≥80 years of age
  • Affects approximately 1 million people in the United States and 5 million worldwide

Etiology and Pathophysiology

Dopamine depletion in the substantia nigra and the nigrostriatal pathways results in the major motor complications of PD.

  • Pathologic hallmark: selective loss of dopamine-containing neurons in the pars compacta of the substantia nigra
  • Loss of neurons accompanied by presence of Lewy bodies, pale bodies (predecessor of the Lewy body), and Lewy neuritis

Genetics
Mutations in multiple autosomal dominant and autosomal recessive genes have been linked to PD/parkinsonian syndrome particularly when the age at symptom onset is <50 years. Genes investigated in PD include SNCA, Parkin, PINK1, DJ-1, and LRRK2.

Risk Factors

  • Age and family history of PD or tremor are the greatest risk factors.
  • History of smoking as well as coffee and caffeine intake may reduce risk.
  • Weak association with exposure to toxins (herbicides and insecticides); however, relationship is not clear.

Commonly Associated Conditions

Non–motor-associated symptoms include cognitive abnormalities, autonomic dysfunction (e.g., constipation, urinary urgency), sleep disturbances, mental status changes (depression, psychosis, hallucinations, dementia), orthostatic hypotension, and pain.

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Citation

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TY - ELEC T1 - Parkinson Disease ID - 117549 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117549/all/Parkinson_Disease PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -