9.2 (clinical) Parkinsons history and evaluation Flashcards
What are the cardinal features of Parkinsons?
Tremor
Rigidity/stiffness
Bradykinesia (slow movement)
Postural instability
What are the Parkinson mimics?
Non degenerative: vascular, trauma, NPH, SDH, antipsychotic
Degenerative: diffuse lewy body disease, progressive supranuclear palsy, cortical basal degeneration, multiple systems atrophy
What is the features of a parkinsonian tremor?
At rest, postural and unilateral
Do not spill or change writing
Benign tremulos form
What are the non motor features of Parkinsons?
Apathy Anosmia REM sleep decreases Fatigue and pain Dribbling of saliva Urgency/constipation Panic attacks
What are the red flags that will suggest a Parkinson mimic?
Symmetrical onset Absence of tremor Motor weakness Dysautonomia Rapid onset Dystonia Apraxia
What are the symptoms of progressive supranuclear palsy?
Frequent falls (down stairs) Axial involvement, retropulsion
What are the symptoms that suggest multiple systems atrophy?
Rapid progression
Dysphagia, stridor
Dysautonomia
What are the symptoms that suggest cortico basal degeneration?
Alien hand phenomenon
Dystonia, myoclonus
Hemispatial neglect
Apraxia
What are the symptoms that suggest diffuse lewy body disease?
Cognitive decline
Hallucinations
What is the gold standard for the diagnosis of parkinsons?
levo dopa response
What are the states of PD?
On, off, wearing off, dyskinesias, freezing, delayed on
What causes dyskinesia in PD patients?
Usually due to overmedication and is the twisting that you see
Patients tend to prefer this than the tremor that comes with PD
What are the side effects of PD medication?
Confusion, hallucination Urinary retention Drowsiness Valvulopathy Serosal fibrosis Gambling/hypersexuality Hypotension
