Parkinson disease

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Definition

  • Degenerative neurological disorder characterized by progressive bradykinesia, rest tremor, rigidity, and postural instability

Pathophysiology

  • Destruction of substantia nigra

Differential Diagnosis

Clinical Presentation

  • 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)
  • ...