Parkinsons disaese
The stages Roberto Rico
History
• 1817 James Parkinson
• 1867 Jean-‐Mar6n Charcot • Bradykinesia • Dysautonomia
• Pain
• 1990 Disease modifying efforts
Symptoms of Parkinson’s Disease1-‐5
Motor symptoms Nonmotor symptoms • Tremor at rest
• Bradykinesia
• Rigidity
• Postural instability
• Other (eg, dysarthria, shuffling gate, dystonia)
• Neuropsychiatric (eg, dementia, cognitive decline, depression, anxiety, psychosis, apathy)
• Sensory (eg, hyposmia, pain, paresthesias)
• Sleep disturbances (eg, RBD, RLS, sleep apnea, sleep attacks, daytime somnolence, insomnia)
• Autonomic dysfunction
• Other (eg, fatigue, weight loss)
RBD = rapid eye movement behavior disorder; RLS = restless legs syndrome. 1. Berg. Neurodegener Dis. 2008;5:133-‐136. 2. Jankovic. J Neurol Neurosurg Psychiatry. 2008;79:368-‐376. 3. Thanvi et al. Postgrad Med J. 2003;79:561-‐565. 4. Weintraub et al. Am J Manag Care. 2008;14:S40-‐S48. 5. Zesiewicz et al. Expert Rev Neurother. 2006;6:1811-‐1822.
Clinical Diagnosis
• Tremor • Rigidity • Bradykinesia
• Suppor6ng features – Assymetric symptoms
– Other parkinsonism
Early diagnos6cs
• Focus on non-motor symptoms
• Biomarker development
• Genetic contribution (Genome wide association)
• Disaese modifying treatments
Neuro imaging in PD
PD Pathology
• Alpha-‐synuclein
• Widely described in other 6ssues
• Outside the nervous system • Autonomic nerves heart,gut,prstate
• Skin 6ssue
Pathology in M.Parkinson
Parkinson Associated Risk Syndrome
• PARS
• Prephysiological • Preclinical • Premotor
• prediagnos6c
Early Nonmotor Signs of PD
• Probable early signs – Cons6pa6on – Olfactory deficit – REM sleep behavior disorder – Depression
• Possible early signs – Apathy – Fa6gue – Anxiety
PD, Parkinson’s disease; REM, rapid eye movement. Chaudhuri et al. Lancet Neurol. 2006;5(3):235-‐245.
Cardinal signs
• Res6ng tremor
• Bradykinesia
• Rigidity
• Postural instability
Nonmotor Features of PD
Psychiatric disorders1
• Depression in up to 40% of patients • Anxiety in ~30% of patients • Psychosis • Behavioural disorders
Cognitive disorders1,2 • Mild cognitive impairment • Dementia in 15% to 40% of patients
Sleep abnormalities1,3 • >70% of patients • REM sleep behavior disorder
Autonomic dysfunction1-3
• Constipation • Orthostatic hypotension • Urinary & Sexual Dysfunction
Sensory3 • Olfactory dysfunction
Miscellaneous1,2 • Fatigue and weight loss • Pain
PD, Parkinson’s disease; REM, rapid eye movement. 1. Thanvi et al. Postgrad Med J. 2003;79(936):561-‐565. 2. Fahn and Sulzer. NeuroRx. 2004;1(1):139-‐154. 3. Jankovic. J Neurol Neurosurg Psychiatry. 2008;79(4):368-‐376.
Non-‐motor
• Depression • Anxiety • Psychosis • Demen6a
• Sleep disfunc6on • Behavioral disorders
Non-‐motor
• Autonomic dysfunc6on • Cardiovascular dysfunc6on • Gastro intes6nal symptoms
• Urinary and sexual dysfunc6on • Hyperhydrosis • Hyposmia
• Pain • Visual disturbances
Future perspec6ve for non motor signs
• Underrecognizedand undertreated
• Important source of disability
• Early diagnosis and disaese modifying treatments
• Not only dopaminergic
conclusions • Non-‐motor symptoms are ofen an integral part of the disaese
• Non motor symptoms worsen quality of life for PD pa6ents
• Early diagnosis is aimed at disaese modifying treatments