Parkinson's disease
Incidental findings
+ve signs 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
Differential diagnosis Parkinsonian disorder, most common idiopathic Parkinson’s disease
Function ?Disabled
Tests
Causes Parkinsonism
Idiopathic
Anoxic brain damage
Postencephalitic
MPTP
Parkinson+: MSA, supranuclear palsy
Extensions

  • General: Glabellar tap
  • Gait: Slow to initiate movement. Festinant shuffling gait. Check for righting reflex.
  • Tremor: Emphasize by mental distraction – ask patient to count backwards from 20
  • Rigidity: Assess upper limb tone; ask patient to move other arm up and down at the same time
  • Bradykinesia: Ask patient to open and close hand quickly
  • Function: ‘I would like to see the patient write’ ‘Undo button’ ‘Take a sip of water’
Assess for other parkinsonian conditions:-

  • Lying standing BP (multisystem atrophy)
  • Eye movement, particularly upwards gaze (Supranuclear palsy)
  • Cognitive function (Lewy body dementia)
Notes

  • Rx: L-Dopa with decarboxylase inhibitor (carbidopa/benserazide)
  • Ropenirole (D2 agonist) reduces risk of dyskinesia but not on/off. Selegiline (MAO B inhibitor) dilays need for levodopa in early disease
  • Deep brain stimulation of globus pallidus and subthalamic nucleus
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