Parkinson's disease physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
In the appearance of PD patients we can notice that the blinking rate of spontaneous blinking is lower than normal but voluntary blinking is similar to general population. The other finding in PD patient is that their spontaneous facial expressions are less frequent and less varied in comparison to normal people (hypomimia)
In physical examination the have Cogwheel rigidity, Resting tremor, Gait problems, Bradykinesia, Olfactory dysfunction and Orthostatic hypotension.
Physical Examination
Appearance
- In the appearance of PD patients we can notice that the blinking rate of spontaneous blinking is lower than normal but voluntary blinking is similar to general population.[1] The other finding in PD patient is that their spontaneous facial expressions are less frequent and less varied in comparison to normal people (hypomimia).[2]
Neuromascular
- Cogwheel rigidity: when we want to move the patient's joint passively, there is a ratchety pattern of resistance and relaxation and overally there is a higher resistance against our passive move.[3][4]
- Resting tremor: we ask the patient to relax his/her arms and start talking about something else to distract him/her. we can see that there is resting tremor unilaterally or bilateraly with higher severity in one side.[5]
- Gait problems: PD patients have balance and gait problems ( shuffling gait)[6]
- Bradykinesia: these patients have slow movements in examinations.[7]
- Olfactory dysfunction: Deficits in odor identification and discrimination are common in PD[8]
- Orthostatic hypotension: Orthostatic hypotension can be seen in PD patients due to autonomic dysfunction.[9]
References
- ↑ Agostino R, Bologna M, Dinapoli L, Gregori B, Fabbrini G, Accornero N, Berardelli A (April 2008). "Voluntary, spontaneous, and reflex blinking in Parkinson's disease". Mov. Disord. 23 (5): 669–75. doi:10.1002/mds.21887. PMID 18175339.
- ↑ Dumer AI, Oster H, McCabe D, Rabin LA, Spielman JL, Ramig LO, Borod JC (March 2014). "Effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on hypomimia in Parkinson's disease". J Int Neuropsychol Soc. 20 (3): 302–12. doi:10.1017/S1355617714000046. PMID 24524211.
- ↑ Deuschl G, Bain P, Brin M (1998). "Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee". Mov. Disord. 13 Suppl 3: 2–23. PMID 9827589.
- ↑ LANCE JW, SCHWAB RS, PETERSON EA (March 1963). "Action tremor and the cogwheel phenomenon in Parkinson's disease". Brain. 86: 95–110. PMID 13928399.
- ↑ Scott RM, Brody JA, Schwab RS, Cooper IS (July 1970). "Progression of unilateral tremor and rigidity in Parkinson's disease". Neurology. 20 (7): 710–4. PMID 5463541.
- ↑ Koller WC, Glatt S, Vetere-Overfield B, Hassanein R (April 1989). "Falls and Parkinson's disease". Clin Neuropharmacol. 12 (2): 98–105. PMID 2720700.
- ↑ Pagano G, Ferrara N, Brooks DJ, Pavese N (April 2016). "Age at onset and Parkinson disease phenotype". Neurology. 86 (15): 1400–7. doi:10.1212/WNL.0000000000002461. PMC 4831034. PMID 26865518.
- ↑ Tissingh G, Berendse HW, Bergmans P, DeWaard R, Drukarch B, Stoof JC, Wolters EC (January 2001). "Loss of olfaction in de novo and treated Parkinson's disease: possible implications for early diagnosis". Mov. Disord. 16 (1): 41–6. PMID 11215591.
- ↑ Verbaan D, Marinus J, Visser M, van Rooden SM, Stiggelbout AM, van Hilten JJ (July 2007). "Patient-reported autonomic symptoms in Parkinson disease". Neurology. 69 (4): 333–41. doi:10.1212/01.wnl.0000266593.50534.e8. PMID 17646625.