Parkinson's disease physical examination: Difference between revisions
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{{Parkinson's disease}} | {{Parkinson's disease}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Fs}} | ||
==Overview== | ==Overview== | ||
In the appearance of [[Parkinson's disease|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 [[Parkinson's disease|PD]] patient is that their spontaneous [[Facial expression|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== | ==Physical Examination== | ||
===Appearance=== | ===Appearance=== | ||
In the appearance of [[Parkinson's disease|PD]] patients we can notice that the [[blinking]] rate of spontaneous blinking is lower than normal but voluntary blinking is similar to general population.<ref name="pmid18175339">{{cite journal |vauthors=Agostino R, Bologna M, Dinapoli L, Gregori B, Fabbrini G, Accornero N, Berardelli A |title=Voluntary, spontaneous, and reflex blinking in Parkinson's disease |journal=Mov. Disord. |volume=23 |issue=5 |pages=669–75 |date=April 2008 |pmid=18175339 |doi=10.1002/mds.21887 |url=}}</ref> The other finding in [[Parkinson's disease|PD]] patient is that their spontaneous [[Facial expression|facial expressions]] are less frequent and less varied in comparison to normal people ([[hypomimia]]).<ref name="pmid24524211">{{cite journal |vauthors=Dumer AI, Oster H, McCabe D, Rabin LA, Spielman JL, Ramig LO, Borod JC |title=Effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on hypomimia in Parkinson's disease |journal=J Int Neuropsychol Soc |volume=20 |issue=3 |pages=302–12 |date=March 2014 |pmid=24524211 |doi=10.1017/S1355617714000046 |url=}}</ref> | * In the appearance of [[Parkinson's disease|PD]] patients we can notice that the [[blinking]] rate of spontaneous blinking is lower than normal but voluntary blinking is similar to general population.<ref name="pmid18175339">{{cite journal |vauthors=Agostino R, Bologna M, Dinapoli L, Gregori B, Fabbrini G, Accornero N, Berardelli A |title=Voluntary, spontaneous, and reflex blinking in Parkinson's disease |journal=Mov. Disord. |volume=23 |issue=5 |pages=669–75 |date=April 2008 |pmid=18175339 |doi=10.1002/mds.21887 |url=}}</ref> The other finding in [[Parkinson's disease|PD]] patient is that their spontaneous [[Facial expression|facial expressions]] are less frequent and less varied in comparison to normal people ([[hypomimia]]).<ref name="pmid24524211">{{cite journal |vauthors=Dumer AI, Oster H, McCabe D, Rabin LA, Spielman JL, Ramig LO, Borod JC |title=Effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on hypomimia in Parkinson's disease |journal=J Int Neuropsychol Soc |volume=20 |issue=3 |pages=302–12 |date=March 2014 |pmid=24524211 |doi=10.1017/S1355617714000046 |url=}}</ref> | ||
===Neuromascular=== | ===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.<ref name="pmid9827589">{{cite journal |vauthors=Deuschl G, Bain P, Brin M |title=Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee |journal=Mov. Disord. |volume=13 Suppl 3 |issue= |pages=2–23 |date=1998 |pmid=9827589 |doi= |url=}}</ref><ref name="pmid13928399">{{cite journal |vauthors=LANCE JW, SCHWAB RS, PETERSON EA |title=Action tremor and the cogwheel phenomenon in Parkinson's disease |journal=Brain |volume=86 |issue= |pages=95–110 |date=March 1963 |pmid=13928399 |doi= |url=}}</ref> | * 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.<ref name="pmid9827589">{{cite journal |vauthors=Deuschl G, Bain P, Brin M |title=Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee |journal=Mov. Disord. |volume=13 Suppl 3 |issue= |pages=2–23 |date=1998 |pmid=9827589 |doi= |url=}}</ref><ref name="pmid13928399">{{cite journal |vauthors=LANCE JW, SCHWAB RS, PETERSON EA |title=Action tremor and the cogwheel phenomenon in Parkinson's disease |journal=Brain |volume=86 |issue= |pages=95–110 |date=March 1963 |pmid=13928399 |doi= |url=}}</ref> | ||
* Resting tremor: we ask the patient to relax his/her [[Arm|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.<ref name="pmid5463541">{{cite journal |vauthors=Scott RM, Brody JA, Schwab RS, Cooper IS |title=Progression of unilateral tremor and rigidity in Parkinson's disease |journal=Neurology |volume=20 |issue=7 |pages=710–4 |date=July 1970 |pmid=5463541 |doi= |url=}}</ref> | |||
Resting tremor: we ask the patient to relax his/her [[Arm|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.<ref name="pmid5463541">{{cite journal |vauthors=Scott RM, Brody JA, Schwab RS, Cooper IS |title=Progression of unilateral tremor and rigidity in Parkinson's disease |journal=Neurology |volume=20 |issue=7 |pages=710–4 |date=July 1970 |pmid=5463541 |doi= |url=}}</ref> | * Gait problems: [[Parkinson's disease|PD]] patients have balance and [[gait]] problems ( [[shuffling gait]])<ref name="pmid2720700">{{cite journal |vauthors=Koller WC, Glatt S, Vetere-Overfield B, Hassanein R |title=Falls and Parkinson's disease |journal=Clin Neuropharmacol |volume=12 |issue=2 |pages=98–105 |date=April 1989 |pmid=2720700 |doi= |url=}}</ref> | ||
* Bradykinesia: these patients have slow movements in examinations.<ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |pmc=4831034 |doi=10.1212/WNL.0000000000002461 |url=}}</ref> | |||
Gait problems: [[Parkinson's disease|PD]] patients have balance and [[gait]] problems ( [[shuffling gait]])<ref name="pmid2720700">{{cite journal |vauthors=Koller WC, Glatt S, Vetere-Overfield B, Hassanein R |title=Falls and Parkinson's disease |journal=Clin Neuropharmacol |volume=12 |issue=2 |pages=98–105 |date=April 1989 |pmid=2720700 |doi= |url=}}</ref> | * Olfactory dysfunction: Deficits in [[odor]] identification and discrimination are common in [[Parkinson's disease|PD]]<ref name="pmid11215591">{{cite journal |vauthors=Tissingh G, Berendse HW, Bergmans P, DeWaard R, Drukarch B, Stoof JC, Wolters EC |title=Loss of olfaction in de novo and treated Parkinson's disease: possible implications for early diagnosis |journal=Mov. Disord. |volume=16 |issue=1 |pages=41–6 |date=January 2001 |pmid=11215591 |doi= |url=}}</ref> | ||
* Orthostatic hypotension: [[Orthostatic hypotension]] can be seen in [[Parkinson's disease|PD]] patients due to [[autonomic dysfunction]].<ref name="pmid17646625">{{cite journal |vauthors=Verbaan D, Marinus J, Visser M, van Rooden SM, Stiggelbout AM, van Hilten JJ |title=Patient-reported autonomic symptoms in Parkinson disease |journal=Neurology |volume=69 |issue=4 |pages=333–41 |date=July 2007 |pmid=17646625 |doi=10.1212/01.wnl.0000266593.50534.e8 |url=}}</ref> | |||
Bradykinesia: these patients have slow movements in examinations.<ref name="pmid26865518">{{cite journal |vauthors=Pagano G, Ferrara N, Brooks DJ, Pavese N |title=Age at onset and Parkinson disease phenotype |journal=Neurology |volume=86 |issue=15 |pages=1400–7 |date=April 2016 |pmid=26865518 |pmc=4831034 |doi=10.1212/WNL.0000000000002461 |url=}}</ref> | |||
Olfactory dysfunction: Deficits in [[odor]] identification and discrimination are common in [[Parkinson's disease|PD]]<ref name="pmid11215591">{{cite journal |vauthors=Tissingh G, Berendse HW, Bergmans P, DeWaard R, Drukarch B, Stoof JC, Wolters EC |title=Loss of olfaction in de novo and treated Parkinson's disease: possible implications for early diagnosis |journal=Mov. Disord. |volume=16 |issue=1 |pages=41–6 |date=January 2001 |pmid=11215591 |doi= |url=}}</ref> | |||
Orthostatic hypotension: [[Orthostatic hypotension]] can be seen in [[Parkinson's disease|PD]] patients due to [[autonomic dysfunction]]. | |||
==References== | ==References== | ||
Latest revision as of 15:41, 21 December 2018
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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.