Parkinsonism

In patients with suspected Parkinson’s disease, accurately distinguish idiopathic Parkinson’s disease from atypical Parkinson’s disease (e.g., disease at a young age, drug-related disease), as treatment differs.
In the care of all patients with Parkinson’s disease, involve other health care professionals to enhance the patient’s functional status.
In an elderly patient with a deterioration in functional status, look for and recognize Parkinson’s disease when it is present, as it is a potentially reversible contribution to the deterioration.
In a patient with a tremor, do an appropriate physical examination (e.g., observation, use of techniques to enhance the tremor) to distinguish the resting tremor of parkinsonism from other (e.g., essential) tremors.
As part of the management of patients with Parkinson’s disease, identify anticipated side effects of medications, especially those with which you are unfamiliar.
As part of the ongoing follow-up care of patients with Parkinson’s disease:
- Assess functional status.
- Monitor them for medication side effects.
- Look for other problems (e.g., depression, dementia, falls, constipation), as they are more common

General Overview

>60yo
Resting tremor, often unilateral, 4-6 Hz (cycles per second), pill-rolling, increased with stress, decreased with voluntary activity
Muscle rigidity/cogwheeling (resistance to passive movement)
Bradykinesia (slow movements)
Postural instability, falls
Shuffling gait, decreased arm swing, unsteady turning, difficulty stopping, stooped/flexed posture
Mask-life facial expression, infrequent blinking
Speech changes (hypophonia), micrographia
Non-motor: Constipation, rapid eye movement (REM) sleep disorder, depression, olfaction impairment, personality changes

Young <60yo
Secondary causes: Drug-induced (Antipsychotics, antiemetics, CCB), Head trauma, Wilson disease, cerebrovascular, CNS infections
Rapid progression (motor symptoms, dysphonia)
Early autonomic dysfunction (urinary incontinence, syncope, orthostatic hypotension), r/o multisystem atrophy parkinsonism
Early recurrent falls (more than once a year within 3y of onset)
Bilateral symmetric symptoms at onset
Absent resting tremor
Poor response to levodopa
Ocular movement disorder, r/o supranuclear palsy

References:

parkinsons.pdf

Google Sites

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