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Parkinson’s disease

Parkinson’s disease. Bill Hall, Natasha Lawson, Robert Hird. James Parkinson. Apothecary Political activist Geologist Watched people from his window Talked to them in the street Wrote a treatise. Each GP will have. 3-4 patients with Parkinson’s Disease Nearly all male

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Parkinson’s disease

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  1. Parkinson’s disease Bill Hall, Natasha Lawson, Robert Hird

  2. James Parkinson • Apothecary • Political activist • Geologist • Watched people from his window • Talked to them in the street • Wrote a treatise

  3. Each GP will have • 3-4 patients with Parkinson’s Disease • Nearly all male • Mean age at onset 65 • But 5% under 40 • Genetic traits

  4. Famous people with early PD? Ray Kennedy Michael J Fox Muahhed Ali

  5. Famous people with early PD?

  6. The classic features • Parkinson's disease is a clinical diagnosis. • Slowing of movement (bradykinesia) • Paucity of movement (hypokinesia) • Resting tremor • Rigidity • Postural instability • Asymmetric start...

  7. Parkinson's disease unlikely if... • Frequent early falls • Prominent early dementia • Failure to respond to L-dopa therapy • Abnormal neurology • Rapid progression with early loss of mobility.

  8. Early features • Fatigue • Stiffness • Reduced arm swing • Heavy legs • Facial expression • Resting tremor

  9. Diagnostic testing

  10. Later features • Posture • Where is the centre of gravity?

  11. Impact • Daily living activities • Mobility • Communication • Relationships • Sexual function • dependency

  12. Non motor effects "doctors see Parkinson's disease as a problem from the neck up, but patients see it as a problem from the neck down."

  13. Non motor effects • Depression • Constipation • Sleep disorders • Dementia • Incontinence • Sexual dysfunction • Sweating • Hypotension

  14. Drugs • Levodopa • Dopamine agonists • Amantidine • Selegeline • Rasagiline • Entacapone • Anticholinergics

  15. Drug side effects • GI effects • Extinction • Impulse control • Pathological gambling • Hypersexuality • Compulsive eating • Punding • Visual hallucinations

  16. Visual hallucinations – I digress...

  17. Using visual hallucinations to good effect

  18. GP’s role?

  19. Teamwork • Specialist • Parkinson’s Specialist Nurse • OT • Physio • Dietician • Speech therapist • Social care • Carers

  20. Resources • Parkinson’s Society • Information • Resources • Non-motor questionnaire • BMJ eLearning

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