Parkinson Disease – Diagnosis

The diagnosis of Parkinson’s disease is purely based on what you see, hear and feel at the bedside.
1.  Resting tremor
2.  Rigidity
3.  Bradykinesia
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

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