Parkinsonism

Know when to suspect Parkinson’s disease. When it is suspected, consider whether it is atypical or not. Treatment options will differ based on the underlying details.

Physical exam must be utilized to differentiate the tremor of parkinsonism from other causes of tremor. Medications used to treat Parkinson’s disease come with a variety of side effects which need to be anticipated and identified.

Other problems might be more common in Parkinson’s disease, such as depression, anxiety, and sleep disorders which must also be identified.

Objectives

1. In patients with suspected Parkinson’s disease, accurately distinguish idiopathic Parkinson’s disease from atypical Parkinson’s disease (e.g., disease at a young age, drug-related disease), as treatment differs.
2. In the care of all patients with Parkinson’s disease, involve other health care professionals to enhance the patient’s functional status.
3. In an elderly patient with a deterioration in functional status, look for and recognize Parkinson’s disease when it is present, as it is a potentially reversible contribution to the deterioration.
4. In a patient with a tremor, do an appropriate physical examination (e.g., observation, use of techniques to enhance the tremor) to distinguish the resting tremor of parkinsonism from other (e.g., essential) tremors.
5. As part of the management of patients with Parkinson’s disease, identify anticipated side effects of medications, especially those with which you are unfamiliar.
6. As part of the ongoing follow-up care of patients with Parkinson’s disease:
   • Assess functional status
   • Monitor them for medication side effects
   • Look for other problems (e.g., depression, dementia, falls, constipation), as they are more common