Parkinson's Disease
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Signs
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General: Monotonous speech, paucity of facial expression, drooling saliva
Gait: Festinating, absence of arm swing
Tremor: Pill-rolling 3-5Hz tremor
Rigidity: Lead pipe, Cog-wheel
Bradykinesia
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Differential diagnosis
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Parkinsonian disorder, most common idiopathic Parkinson's disease
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Function
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?Disabled
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Causes Parkinsonism
Idiopathic
Anoxic brain damage
Postencephalitic
MPTP
Parkinson+: multi-system atrophy, supranuclear palsy
Extensions
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General: Glabellar tap
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Gait: Slow to initiate movement. Festinant shuffling gait. Check for righting reflex.
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Tremor: Emphasize by mental distraction - ask patient to count backwards from 20
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Rigidity: Assess upper limb tone; ask patient to move other arm up and down at the same time
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Bradykinesia: Ask patient to open and close hand quickly
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Function: 'I would like to see the patient write' 'Undo button' 'Take a sip of water'
Assess for other parkinsonian conditions:
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Lying standing BP (multisystem atrophy)
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Eye movement, particularly upwards gaze (Supranuclear palsy)
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Cognitive function (Lewy body dementia)
Notes
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Rx: L-Dopa with decarboxylase inhibitor (carbidopa/benserazide)
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Ropenirole (D2 agonist) reduces risk of dyskinesia but not on/off.
Selegiline (MAO B inhibitor) dilays need for levodopa in early disease
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Deep brain stimulation of globus pallidus and subthalamic nucleus
