Parkinson’s Disease

Parkinson’s Disease is a degenerative movement disorder resulting from the death of the dopaminergic neurons in the substantia nigra.

There aren’t any definitive blood tests or imaging for Parkinson’s, so it really comes down to a solid neurological examination.

Generally bradykinesia (slow movement) plus one of the other two cardinal signs

  1. Rigidity (cogwheel)
  2. Tremor (pill rolling)

The other movement signs seen in Parkinson’s

  1. Shuffling gait
  2. Mask-like expression
  3. Postural instability: this is tested with the “pull test” – the examiner stands behind the patient and firmly pulls the patient by the shoulders. Someone with normal postural reflexes should only need to take one step back, someone with postural instability will fall or need to take multiple steps backwards.

Hallmarks of Alzheimer’s Dementia

For a dementia to be considered to be Alzheimer’s, it must meet specific criteria

  1. Memory impairment
  2. 1 or more of:
    • Aphasia: language disturbance
    • Apraxia: inability to carry out motor activities despite intact motor function
    • Agnosia: can’t identify objects despite intact motor function
    • Disturbance in executive functioning (SOAP – sequencing, organizing, abstracting, planning)
  3. Cognitive deficits (in 1 and 2) are a decline from functioning and cause impairment in social or occupational functioning
  4. Gradual onset with ongoing decline
  5. Cognitive decline not due to other processes, medical illness (thyroid, B12, folate, hypercalcemia, HIV), substance
  6. Not due to delirium
  7. Not due to mood, anxiety or psychotic disorder

 

 

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