Parkinson disease
Description
- Progressive alpha-synucleinopathy: nigrostriatal dopaminergic loss + widespread Lewy pathology
- Cardinal features: bradykinesia (mandatory) + resting tremor and/or rigidity
- Postural instability comes later - early falls point away from PD
- Bradykinesia = slowness with decrement in amplitude/speed on repetition (finger tap, hand open-close, foot tap)
- Tremor - 4-6 Hz, rest, pill-rolling, asymmetric, suppressed on action, worse with distraction/walking
- Re-emergent tremor after a latency on posture is still PD tremor
- Rigidity - lead-pipe, cogwheel when tremor superimposed; enhanced by contralateral voluntary movement
- Gait: stooped, shuffling, reduced arm swing, festination, freezing at turns and doorways; retropulsion on the pull test
- Other motor: hypomimia, hypophonia, micrographia, dysphagia, drooling
- Asymmetry at onset is the rule - symmetrical disease should make you doubt the diagnosis
Non-motor - often precede motor onset by years
- REM sleep behaviour disorder (the strongest prodromal marker of any synucleinopathy)
- Hyposmia, constipation, depression, anxiety
- Later: orthostatic hypotension, urinary urgency, erectile dysfunction, cognitive impairment, psychosis, pain, fatigue
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