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Last Updated: 1/24/2013  

Parkinson's Disease

  • 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.

  • 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.
Author(s) and Disclosures:
Paul Tuite, MD received honorarium from Pfizer, Pharmacia, Novartis, AstraZeneca, SmithKlineBeecham. Melissa Gaines, MD has nothing to disclose.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD, FACP; Richard Lynn, MD, FACP.

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