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==Diagnosis==
==Diagnosis==
Shown below is an [[Algorithm (medical)|algorithm]] summarizing the [[diagnosis]] of [[Gait abnormality|Parkinson's disease]] according to the American Academy of Neurology guidelines:<ref name="Marinode Souza2020">{{cite journal|last1=Marino|first1=Bianca L.B.|last2=de Souza|first2=Lucilene R.|last3=Sousa|first3=Kessia P.A.|last4=Ferreira|first4=Jaderson V.|last5=Padilha|first5=Elias C.|last6=da Silva|first6=Carlos H.T.P.|last7=Taft|first7=Carlton A.|last8=Hage-Melim|first8=Lorane I.S.|title=Parkinson’s Disease: A Review from Pathophysiology to Treatment|journal=Mini-Reviews in Medicinal Chemistry|volume=20|issue=9|year=2020|pages=754–767|issn=13895575|doi=10.2174/1389557519666191104110908}}</ref><br><br>
Shown below is an [[Algorithm (medical)|algorithm]] summarizing the [[diagnosis]] of [[Gait abnormality|Parkinson's disease]] according to the American Academy of Neurology guidelines:<ref name="Marinode Souza2020">{{cite journal|last1=Marino|first1=Bianca L.B.|last2=de Souza|first2=Lucilene R.|last3=Sousa|first3=Kessia P.A.|last4=Ferreira|first4=Jaderson V.|last5=Padilha|first5=Elias C.|last6=da Silva|first6=Carlos H.T.P.|last7=Taft|first7=Carlton A.|last8=Hage-Melim|first8=Lorane I.S.|title=Parkinson’s Disease: A Review from Pathophysiology to Treatment|journal=Mini-Reviews in Medicinal Chemistry|volume=20|issue=9|year=2020|pages=754–767|issn=13895575|doi=10.2174/1389557519666191104110908}}</ref><br><br>
<br>
<be>
 
 
{{Family tree/start}}
{{Family tree/start}}
{{familytree | | | | | | | | A01 |A01=Prodromal period }}  
{{familytree | | | | | | | | | | | A01 |A01=[[Prodromal symptoms|Prodromal period]] }}  
{{familytree | | | | |,|-|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | | B02 | | |B01='''Possible early symptoms of Parkinson disease'''
{{familytree | | | | | B01 | | | | | | | | | B02 | | |B01='''Possible early [[symptoms]] of [[Parkinson disease]]'''
<br>• Rapid eye movement sleep behavior disorder
<br>• [[Rapid eye movement]] [[sleep]] [[behavior]] [[disorder]]
<br>• Autonomic symptoms (eg, constipation, orthostatic hypotension)
<br>• [[Autonomic dysfunction|Autonomic symptoms]] (eg, [[constipation]], [[orthostatic hypotension]])
<br>• Hyposmia |B02='''Family history'''
<br>• [[Hyposmia]] |B02='''Family history'''
<br>• First-degree relative with Parkinson disease
<br>• First-degree relative with [[Parkinson disease]]
<br>• Known Parkinson disease gene mutation in family }}
<br>• Known [[Parkinson disease]] [[gene mutation]] in family }}
{{familytree | | | | |`|-|-|-|-|v|-|-|-|-|'| }}
{{familytree | | | | | | |`|-|-|-|-|v|-|-|-|-|'| }}
{{familytree | | | | B01 | | | B02 | | | B03 | |B01='''Physical examination''' <br>Findings must include
{{familytr | | | | | | | |,|-|-|-|-|+|-|-|-|-|-|.|}}
<br>• Bradykinesia
{{familytree | | | | | | B01 | | | B02 | | | B03 | |B01='''Physical examination''' <br>Findings must include
<br>• Rigidity and/or tremor <br>Findings may include
<br>• [[Bradykinesia]]
<br>• Rigidity and/or [[tremor]] <br>Findings may include
<br>• Hypophonia
<br>• Hypophonia
<br>• Micrographia
<br>• Micrographia
<br>• Decreased arm swing
<br>• Decreased arm swing
<br>• Short step length|B02='''Patient medical history''' <br>Symptoms may include
<br>• Short step length|B02='''Patient medical history''' <br>Symptoms may include
<br>• Slowness
<br>• [[Slowness]]
<br>• Tremor
<br>• [[Tremor]]
<br>• Gait changes
<br>• [[Gait abnormality|Gait changes]]
<br>• Soft voice
<br>• Soft voice
<br>• Decreased facial expression
<br>• Decreased [[facial]] expression
<br>• Depression and/or anxiety |B03='''Other factors''' <br>• Dopamine transporter single-proton emission computed tomography imaging findings
<br>• [[Depression]] and/or [[anxiety]] |B03='''Other factors''' <br>• [[Dopamine]] transporter single-proton emission [[computed tomography]] imaging findings
<br>• Genetic data }}
<br>• [[Genetic]] data }}
{{familytree | | | | |`|-|-|-|-|v|-|-|-|-|'| }}
{{familytree | | | | | | |`|-|-|-|-|+|-|-|-|-|'| }}
{{Family tree/end}}<br><br>
{{familytree | | | | | | | | | | | A01 |A01=Evaluation consistent with [[Parkinson disease]] }}
{{familytree | | | | | | | | | | | |!| | | | }}
{{familytree | | | | | | | | | | | A01 |A01='''Assessment of features potentially indicative of atypical parkinsonism'''
<br>• Rapid progression
<br>• Early and recurrent falls
<br>• Severe early [[dysphonia]] or [[dysarthria]]
<br>• Severe early [[Autonomic dysfunction|autonomic failure]]
<br>• [[Cerebellar]] findings (eg, [[dysmetria]]) }}
{{familytree | | | | | | | | | | | |!| | | | }}
{{familytree | | | | | | | | | | | A01 |A01=All features present? }}
{{familytree | | | | | | |,|-|-|-|-|^|-|-|-|-|.| }}
{{familytree | | | | | | A01 | | | | | | | | A02 |A01=Yes |A02=No }}
{{familytree | | | | | | |!| | | | | | | | | |!| | }}
{{familytree | | | | | | A01 | | | | | | | | |!| |A01=Evaluate for patient response to [[levodopa]] }}
{{familytree | | | | | | |!| | | | | | | | | |!| | }}
{{familytree | | | | | | A01 | | | | | | | | |!| |A01=Response? }}
{{familytree | | |,|-|-|-|^|-|-|-|.| | | | | |!| }}
{{familytree | | A01 | | | | | | A02 |-|-|-| A03 |A01=Yes |A02=No |A03=Consider [[diagnosis]] of atypical [[parkinsonism]] }}
{{familytree | | |!| | | | | | | | | }}
{{familytree | | A01 | | | | | | |A01=Confirmation of [[Parkinson disease]] [[diagnosis]]}}  
{{Family tree/end}}<br><be>
 
 
==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
Shown below is an algorithm summarizing the treatment of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.

Revision as of 03:46, 27 January 2021


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D., Moises Romo, M.D.

Synonyms and keywords:Parkinson's disease management, Parkinson's disease workup, Parkinson's disease approach, approach to Parkinson's disease, Parkinson's disease treatment

Overview

Parkinson's disease is a degenerative movement disorder of the central nervous system. It is characterized by motor symptoms such as bradykinesia, rigidity, and tremor, but also cognitive and comunicative symptoms such as facial masking and dysarthria. These primary symptoms are the results of decreased stimulation of the motor cortex by the basal ganglia, normally caused by the insufficient formation and action of dopamine. Diagnosis is mainly clinical, it may be supported by MRI findings and dopamine transporter single-photon emission computed tomography (DaT SPECT), but definitive diagnosis is made by autopsy. The mainstay of therapy for motor symptoms of Parkinson disease are: Levodopa, dopamine agonists, monoamine oxidase (MAO) B inhibitors, anticholinergic agents, amantadine, catechol-O-methyl transferase (COMT) inhibitors, estrogen and other drugs such as Exenatide, uric acid, isradipine, nilotinib and GDNF infusion. Other therapies will depend on comorbidities.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Parkinson's disease according to the American Academy of Neurology guidelines:[1]

<be>


Template:Familytr

 
 
 
 
 
 
 
 
 
 
Prodromal period
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Possible early symptoms of Parkinson disease


Rapid eye movement sleep behavior disorder
Autonomic symptoms (eg, constipation, orthostatic hypotension)


Hyposmia
 
 
 
 
 
 
 
 
Family history


• First-degree relative with Parkinson disease


• Known Parkinson disease gene mutation in family
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Physical examination
Findings must include


Bradykinesia
• Rigidity and/or tremor
Findings may include
• Hypophonia
• Micrographia
• Decreased arm swing


• Short step length
 
 
Patient medical history
Symptoms may include


Slowness
Tremor
Gait changes
• Soft voice
• Decreased facial expression


Depression and/or anxiety
 
 
Other factors
Dopamine transporter single-proton emission computed tomography imaging findings
Genetic data
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Evaluation consistent with Parkinson disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assessment of features potentially indicative of atypical parkinsonism


• Rapid progression
• Early and recurrent falls
• Severe early dysphonia or dysarthria
• Severe early autonomic failure


Cerebellar findings (eg, dysmetria)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
All features present?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Evaluate for patient response to levodopa
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Response?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
No
 
 
 
Consider diagnosis of atypical parkinsonism
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Confirmation of Parkinson disease diagnosis
 
 
 
 
 
 


<be>


Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

Don'ts

  • The content in this section is in bullet points.

References

  1. 1.0 1.1 1.2 1.3 Marino, Bianca L.B.; de Souza, Lucilene R.; Sousa, Kessia P.A.; Ferreira, Jaderson V.; Padilha, Elias C.; da Silva, Carlos H.T.P.; Taft, Carlton A.; Hage-Melim, Lorane I.S. (2020). "Parkinson's Disease: A Review from Pathophysiology to Treatment". Mini-Reviews in Medicinal Chemistry. 20 (9): 754–767. doi:10.2174/1389557519666191104110908. ISSN 1389-5575.
  2. Fox, Susan H.; Katzenschlager, Regina; Lim, Shen-Yang; Barton, Brandon; de Bie, Rob M. A.; Seppi, Klaus; Coelho, Miguel; Sampaio, Cristina (2018). "International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease". Movement Disorders. 33 (8): 1248–1266. doi:10.1002/mds.27372. ISSN 0885-3185.


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