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

More information of Parkinson Plus Syndrome click here

Classification of Tremor
Resting Tremor	Parkinson’s
Postural/action tremor	Idiopathic, anxiety, drugs, familial
Essential Tremor	Familial
Intention tremor	Cerebellar (increases towards target)
Midbrain tremor	Movement of upper limbs associated with intention tremor