Approach to parkinsonism

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