Signs of Parkinson’s Disease
- mask-like facies
- absence of blinking, glabella tap
- micrographia
- oculogyric crisis
- monotonous speech
- resting tremor: 4-8 Hz – “pill-rolling” (facilitated by mental stimulation, e.g. move contralateral limb)
- cogwheel rigidity
- bradykinesia – loss of normal arm swing
- gait disturbance:
- “shuffling” – small steps and hardly raise feet off ground
- “festination” – difficulty in initiating walking, then hurry
- power is well preserved
- loss of postural righting reflex – do not respond well to drugs (lose balance)
- major tranquilisers – think of psychotropic drugs as causative in younger patients with parkinsonian signs
Articles of Interest
Armstrong MJ, Okun MS. Diagnosis and Treatment of Parkinson Disease: A Review. JAMA. 2020;323(6):548–560. doi:10.1001/jama.2019.22360.
Rizek, Philippe et al. “An update on the diagnosis and treatment of Parkinson disease.” CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne vol. 188,16 (2016): 1157-1165. doi:10.1503/cmaj.151179.
DeMaagd, George, and Ashok Philip. “Parkinson’s Disease and Its Management: Part 1: Disease Entity, Risk Factors, Pathophysiology, Clinical Presentation, and Diagnosis.” P & T : a peer-reviewed journal for formulary management vol. 40,8 (2015): 504-32.
