Parkinsons Disease (PD)

Etiology

  • Progressive depletion of dopamine from substantial nigra, which occurs for unknown reasons
  • Secondary PD assoc w/many conditions, including: meds→ antipsychotics, antiemetics; repeated head trauma→ boxers; toxins→ MPTP; vascular dz; Lewy body dementia

Risk Factors

  • Age > 70

Symptoms

  • Tremor occurs at rest and w/activity
  • Pill rolling tremor of hands
  • Sometimes head bobbing tremor
  • Difficulty starting and stopping movements
  • Balance and gait problems
  • Difficulty swallowing, sometimes assoc w/aspiration
  • Sometimes cognitive decline
  • Symptoms are progressive

Physical Exam Findings

  • Masked facies
  • Characteristic pill-rolling tremor
  • Findings are bilateral, though typically worse on one side
  • Shuffling gait w/limited arm swing and flexed posture
  • Difficulty getting up and starting movement
  • Difficulty turning

Links