Parkinson's Presentation

Overview 

Parkinson’s disease is a progressive neurodegenerative disorder characterised by tremor, rigidity, bradykinesia, and a wide spectrum of non-motor symptoms including sleep disorders, hyposmia, bladder and bowel dysfunction, fatigue, dementia, and other neuropsychiatric symptom. Although the disease has no cure, available treatments effectively control motor symptoms and improve quality of life. Parkinson disease affects approximately 1 percent of persons older than 60 years, and up to 4 percent of those older than 80 years.

Examination

General 

• Mask-like facies
• Resting tremor
  • Pill rolling
• Flexed posture
• Walking aid?

Gait

• Shuffling → Festinating → Difficulty stopping
• Heel to toe difficult
• No arm swing

Movement

• Resting tremor (make them not think about it)
• Propulsion and Retropulsion (not recommended)
• Bradykinesia
  • Tapping the fingers
  • Twiddling
  • Opening door knob
• Kinesia Paradoxica (not recommended)
• Orthostatic hypotension

Head

• Titubation
• Dribbling
• Absence of blinking
• Glabbelar tap
• Speech - monotone, soft
• Oculomotor movement - upward gaze problems
  • Supranuclearpalsy - loss of all gaze movement
• Seborrhoea - autonomic dysfunction
• Palmomental Reflex

Arms

• Hypertonia - cogwheel rigidity usually begins asymmetrically
• Micrographia
• Test higher centers of brain..

Differentials for Parkinson's Disease

• Drug induced - Antipsychotics
• Tumour
• Increased intracranial pressure
• Stroke
• Huntington's

Rule out Parkinson Plus syndrome

• Progressive supranuclear palsy
• Multi-system atrophy
• Parkinsonism-dementia-amyotrophic lateral sclerosis complex
• Corticobasal ganglionic degeneration (CBD)
• Dementia with Lewy bodies
  • Mini-mental state examination to distinguish from pure parkinson's disease