The diagnosis of Parkinson’s disease is purely based on what you see, hear and feel at the bedside.
1. Resting tremor
– muscles are inactive (vs action tremor)
– 5 Hz tremor = 300 cycles/min = exact same frequency as atrial flutter!
– “pill-rolling” or supination/pronation tremor
– see “Spasticity vs Rigidity”
– resistance in both flexion and extension
– not velocity-dependent
– no extremity weakness
– count the # of times pt blinks (normal 28-30/min)
– Parkinson’s blink rate much reduced
2 out of 3 = Parkinsonism
– 25% of these don’t have Parkinson’s disease
Three more features increase chance of Parkinson’s disease:
– Asymmetric tremor and rigidity
– No atypical features: no cerebellar symptoms, no difficulty looking down, not on neuroleptics, no profound orthostatic hypotension….
– Respond to L-dopa