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INTRODUCTION
Parkinson’s disease is a chronic
neurodegenerative movement disorder affecting
voluntary and emotional movements and most
commonly seen in the elderly, but is also found
in the young and inexorably progresses leading
to significant disability.
EPIDEMIOLOGY
Primarily a disease of the elderly
Mean age 55, Range 20 - 80 years
Juvenile parkinsonism- Less than 20 years
M/F = 3:2
Prevalence increases with age
Tremors – hands and head develop involuntary movements when at rest; pin-rolling sign (finger and thumb)
Muscle rigidity – arthritis-like stiffness, difficulty in bending or moving limbs; poker face
Brandykinesia – problems chewing, swallowing or speaking; difficulty in initiating movements and controlling fine movements; walking becomes difficult.
Postural instability – humped over appearance, prone to falls
Chemical Balance in Corpus Striatum
Excitatory
Cholinergic
pathway
Inhibitory
Dopaminergic
pathway
BALANCE
Chemical Balance in Corpus Striatum
Excitatory Cholinergic
pathway
Inhibitory
Dopaminergic
pathway
Imbalance
CAUSES
Unclear, but is a number of factors:
– Environmental – toxins
– Free Radicals – there is a increase in post-
mortem brain sections
– Aging – age related decline in dopamine
production
– Genetic – possible, no single gene identified
TREATMENT
The Drugs:
– Dopaminergic drugs (improving dopamine
functioning)
• Levodopa
• Dopamine receptor agonists
• Amantadine
• Selective monoamine oxidase B inhibitors
• Catechol-O-methyltransferase inhibitors
– Antimuscarinic drugs (Ach inhibitors)
Levodopa (Madopar & Sinemet)
Can not administer dopamine directly, as it does
not cross the blood brain barrier
A natural amino acid that the brain converts into
dopamine (replacement therapy) used since the
1960’s
To make it slow release, combined with
benserazide (an enzyme inhibitor) to create co-
beneldopa or co-careldopa (Sinemet)
Dose = 50, 100 or 200mg (12.5, 25 or 50mg)
Although the risk of developing AD increases with age – in most
people with AD, symptoms first appear after age 60 – AD is not a part
of normal aging.
Alzheimer’s disease is an neurodegenerative,
irreversible, progressive brain disease that
slowly destroys memory and thinking skills.
What is Alzheimer’s disease (AD) ?
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PATHOLOGY
The main pathological feature of AD comprise;
Deposition of β Amyloid protein(Aβ) in selective areasof brain like cortex , hippocampus , Amygdala .
Intraneuronal neurofibriliary tangles which comprisesof the aggregates of highly phosphorylated form ofnormal neuronal protein (Tau).
Marked decrease in choline acetytranferase and loss ofcholinergic neuron in brain.
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