Make the Diagnosis: Parkinsonism
Parkinson disease remains a clinical diagnosis. No accurate laboratory or radiologic test is currently available. An acute challenge with levodopa, followed by monitoring for improvement of symptoms, is not useful diagnostically.
Parkinson disease affects 1% of people older than 65 years and 2% of those older than 85 years.2 The prevalence among older patients presenting with general neurologic complaints is almost certainly much higher, but precise figures are unavailable.
Population for Whom Parkinson Disease Should Be Considered
Adults with a tremor or other symptoms noted in Tables 38-4 and 38-5 (see Figure 38-2 for assessment of bradykinesia).
Table 38-4Useful Symptoms for Detecting Parkinson Disease ||Download (.pdf) Table 38-4 Useful Symptoms for Detecting Parkinson Disease
|Symptom (No. of Studies) ||LR+a ||LR–a |
|Shuffling gait (2) ||3.3-15 ||0.32-0.50 |
|Bradykinesia (difficulty rising from a chair) (2) ||1.9-5.2 ||0.39-0.58 |
|Loss of balance (2) ||1.6-6.6 ||0.29-0.35 |
|Tremor (4) ||1.4-11 ||0.24-0.60 |
|Rigidity (3) ||1.3-4.5 ||0.12-0.93 |Table 38-5Useful Signs for Detecting Parkinson Disease ||Download (.pdf) Table 38-5 Useful Signs for Detecting Parkinson Disease
|Signa ||LR+ (95% CI) ||LR– (95% CI) |
|Rigidity and bradykinesia ||4.5 (2.9-7.1) ||0.12 (0.03-0.45) |
|Glabella tap ||4.5 (2.8-7.4) ||0.13 (0.03-0.47) |
|Difficulty walking heel to toe ||2.9 (1.9-4.5) ||0.32 (0.15-0.70) |
|Rigidity ||2.8 (1.8-4.4) ||0.38 (0.19-0.76) |
|Asymmetry of disease ||1.8 (0.98-3.2) ||0.61 (0.41-0.91) |
|Tremor ||1.5 (1.0-2.3) ||0.47 (0.27-0.84) |
Detecting the Likelihood of Parkinson Disease
See Tables 38-4 and 38-5 (see Figure 38-2 for assessment of bradykinesia).
Serial clinical examinations performed by a specialist.
Original Article: Does This Patient Have Parkinson Disease?
A 68-year-old man presents with a 3-month history of right arm tremor at rest. His movements have been slower and he has difficulty getting out of a chair. Physical examination reveals rigidity in the upper limbs. He walks with small steps and has limited ability to swing his arms. His facial expressions are limited.
Why Answer This Question With a Clinical Examination?
With a prevalence estimated between 150 and 200 per 100 000, Parkinson disease (PD) is one of the most common neurologic disorders.1 It is more prevalent in older persons, affecting 1% of those older than ...