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