Parkinson disease
From IDWiki
Background
- Degenerative neurological disorder characterized by progressive bradykinesia, rest tremor, rigidity, and postural instability
Pathophysiology
- Destruction of substantia nigra
Clinical Manifestations
- Rest tremor at 4-6 Hz, inhibited by movement and sleep, worsened by stress
- Pill-rolling
- Rigidity, with increased tone and cog-wheeling
- No spasticity
- Often worse with repeated flexion
- Bradykinesia
- Short, shuffling gait with festination
- Loss of arm swing
- Micrographia
- Postural hypotension
- Glabellar tap reflex, normally stops after 5-10 taps
JAMA Rational Clinical Exam
- Change in speech (LR+ 2.6, LR- 0.73)
- ...
Differential Diagnosis
Management
Non-Motor Symptoms
Psychosis
- Usually worsened by antiparkinson medications
- Evaluate and treat any triggers
- Consider decreasing any anticholinergic drugs, followed by amantadine, dopamine agonists, monoamine oxidase type B inhibitors, and COMT inhibitors, and finally levodopa (as a last resort)
- For refractory symptoms, consider quetiapine, pimavanserin, and clozapine
- Other antipsychotics have higher risk of exacerbating Parkinson disease
Orthostatic Hypotension
- May be caused by the underlying disease or by medications (including levodopa and MAO B inhibitors) that are used to treat it
- Non-medical management includes increased oral fluid (possibly with boluses), salt supplementation, physical counter-maneurvers, abdominal banding, stockings, and elevating the head of the bed
- Pharmacologic treatments include droxidopa, fludrocortisone, and midodrine
