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Last Updated: 1/24/2013  

Parkinson's Disease

Diagnosis
  • Parkinson's disease is a movement disorder characterized by rigidity, tremors (typically at rest), and slow movement (bradykinesia).

  • Additional features supporting the diagnosis of Parkinson's disease include:

    • Definite clinical improvement with levodopa and/or a dopamine agonist

    • Asymmetric onset with persistent asymmetry

  • Parkinsonism may be caused by a variety of etiologies including prior ischemic events; severe head injury; other neurologic, medical, metabolic, genetic and psychiatric disorders; as well as medications and toxins.

  • Parkinson's disease can be diagnosed only after other causes of Parkinsonism have been excluded.

  • The diagnosis of Parkinson's disease is made clinically because there is no readily available diagnostic test.

  • Consult a neurologist to confirm the diagnosis in patients with early Parkinson's disease, those with atypical symptoms, and those with the onset of symptoms before the age of 50.

Therapy
  • Encourage regular exercise.

  • Begin drug therapy for patients with motor dysfunction when disability becomes apparent, adjusting the regimen or adding other agents as the disease progresses.

  • Consider tai chi, deep brain stimulation or other alternative therapies.

  • Manage the non-motor symptoms of sleep disorders, sensory symptoms, manifestations of autonomic dysfunction, and associated psychiatric symptoms, including delirium, hallucinations, and depression, with appropriate medications.

DOI: 10.7326/d243
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Paul Tuite, MD received honorarium from Pfizer, Pharmacia, Novartis, AstraZeneca, SmithKlineBeecham. Melissa Gaines, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, Editor.
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