Clinical approach
- Core features = triad of
- Bradykinesia/akinesia
- Rigidity
- Rest tremor 3-5Hz
- Other features to look for in PD
- Face: hypomimia
- Speech: bradykinesia
- Tremor: synkinesis
- Gait: slow to initiate, shuffling, decreased arm swing, slow to turn
- Posture: postural instability
- Autonomic: postural BP
- Function: micrographia, doing up a button
- Exclude other causes
- Look for evidence of treatment
Causes
- Idiopathic PD
- Neurodegenerative
- ‘Parkinson’s plus’: CBD, PSP, MSA
- HD
- SCAs
- FTD-PD
- Fahr’s
- Drug-induced: antipsychotics, antiemetics
- Toxic/metabolic: Wilson’s, MPTP
- Vascular
- Traumatic: dementia pugilistica
- Infective: encephalitis lethargica