Parkinson's disease

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Background

  • Extrapyramidal movement disorder associated with reduced dopaminergic receptors in substantia nigra

Clinical Features

TRAP mnemonic

  • Tremor (resting)
    • Initially is unilateral tremor of upper extremity, esp finger and thumb ("pill rolling")
    • Dissipates when intentional movement is performed
  • Rigidity (cogwheel)
    • Elicited by causing passive movement of limb through full range of motion
  • Akinesia
    • Slowness of voluntary movement
  • Posture/equilibrium impairment
    • Impaired ability to turn or change direction while walking

Differential Diagnosis

Dementia

Diagnosis

Treatment

  • Dopamine agonists
    • Levodopa  +Carbidopa (peripheral decarboxylase inhibitor) = gold standard
    • pramipexole (Mirapex)
      ropinirole (Requip)
  • Anticholenergics
    • Benztropine
  • Monoamine oxidase inhibitor - blocks DA reuptake
    • selegiline (Eldepryl)
    • rasagiline (Azilect)

Disposition

  • Usually treated as outpatient

See Also

References