CARE OF THE ELDERLY

Take a focused history from a patient with Parkinson’s disease or symptoms suggestive of possible Parkinson’s disease.

It is likely that the patient may have been admitted to hospital with a condition related or unrelated to their Parkinson’s disease (e.g. pneumonia), as opposed to a new presentation of Parkinson’s disease – therefore you should explore their presenting condition in detail, before asking in more detail about the Parkinson’s-like symptoms they have. Include past medical history, drug history, social history, family history – remember to ask appropriate questions to assess for and/or exclude other causes of parkinsonism.

Perform a focused neurological examination of the patient, looking for signs of Parkinsonism and any other examination(s) which may be relevant to their presenting condition.

Document your findings in a systematic manner. You may want to use a local clerking proforma or have a look at this useful summary from Geeky Medics.

Write down 3-5 key differential diagnoses, with the most likely at the top. From this list, suggest one or two key features from the history and/or examination that makes each more and less likely.

Next, consider the differential diagnoses for the patient’s neurological symptoms/signs. Is this likely to Parkinson’s disease or are there any other diagnoses you have considered?

Consider:

• What is the difference between the term parkinsonism and Parkinson’s disease?

• What are the key symptoms and signs of parkinsonism?

• Are there any other less common signs and symptoms of parkinsonism?

• Name as many conditions as you can that may present with parkinsonism.

1. https://radiopaedia.org/cases/normal-ct-brain?lang=gb

2. http://neurovascularmedicine.com/neuroanatomy.php

3. https://www.parkinsons.org.uk/professionals/resources/pd-nil-mouth-medication-dose-calculator

4. https://radiopaedia.org/articles/parkinson-disease-1#:~:text=Parkinson%20disease%20%28PD%29%20%2C%20also%20known%20as%20idiopathic,of%20dopaminergic%20neurons%20in%20the%20substantia%20nigra%20.

5. https://almostadoctor.co.uk/encyclopedia/parkinsons-disease#Drugs