Chapter 186: Parkinson’s Disease
CLINICAL FEATURES
Parkinsonism is a general term used to define a syndrome of bradykinesia (slowness of voluntary movements) with rigidity and/or tremor (Table 186-1); it has a wide differential diagnosis (Table 186-2). Parkinson’s disease (PD) is idiopathic parkinsonism without evidence of more widespread neurologic involvement. PD afflicts >1 million individuals in the United States. Mean age of onset is about 60 years; course progressive over 10–25 years. Tremor (“pill rolling” of hands) at rest (4–6 Hz). Presentation with tremor confined to one limb or one side of body is common. Other findings: rigidity (“cogwheeling”—increased ratchet-like resistance to passive limb movements), bradykinesia, fixed expressionless face (facial masking) with reduced frequency of blinking, hypophonic voice, drooling, impaired rapid alternating movements, micrographia (small handwriting), reduced arm swing, and flexed “stooped” posture with walking, shuffling gait, difficulty initiating or stopping walking, en-bloc turning (multiple small steps required to turn), retropulsion (tendency to fall backwards). Nonmotor aspects of PD include depression and anxiety, cognitive impairment, sleep disturbances, sensation of inner restlessness, loss of smell (anosmia), and disturbances of autonomic function. Normal muscular strength, deep tendon reflexes, and sensory examination. Diagnosis based on history and examination; neuroimaging, EEG, and CSF studies usually normal for age.
CARDINAL MOTOR FEATURES | OTHER MOTOR FEATURES | NONMOTOR FEATURES |
---|---|---|
Bradykinesia Rest tremor Rigidity Postural instability | Micrographia Masked facies (hypomimia) Reduced eye blinking Drooling Soft voice (hypophonia) Dysphagia Freezing | Anosmia Sensory disturbances (e.g., pain) Mood disorders (e.g., depression) Sleep disturbances (e.g., RBD) Autonomic disturbances Orthostatic hypotension Gastrointestinal disturbances Genitourinal disturbances Sexual dysfunction Cognitive impairment/Dementia |
Abbreviation: RBD, rapid eye movement behavior disorder.
Parkinson’s disease Sporadic Genetic Dementia with Lewy bodies | Atypical parkinsonism Multiple-system atrophy (MSA) Cerebellar type (MSA-c) Parkinson type (MSA-p) Progressive supranuclear palsy Parkinsonism Richardson variant Corticobasal syndrome Frontotemporal dementia | Secondary parkinsonism Drug-induced Tumor Infection Vascular Normal-pressure hydrocephalus Trauma Liver failure Toxins (e.g., carbon monoxide, manganese, MPTP, cyanide, hexane, methanol, carbon disulfide) | Neurodegenerative disorders and other forms of parkinsonism Wilson’s disease Huntington’s disease Neurodegeneration with brain iron accumulation SCA 3 (spinocerebellar ataxia) Fragile X–associated ataxia-tremor-parkinsonism Prion disease X-linked dystonia-parkinsonism Alzheimer’s disease with parkinsonism Dopa-responsive dystonia |
Abbreviation: MPTP, 1-methyl-4-phenyl-1,2,5,6-tetrahydropyridine.
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Citation
Kasper, Dennis L., et al., editors. "Chapter 186: Parkinson’s Disease." Harrison's Manual of Medicine, 20th ed., McGraw Hill Inc., 2020. harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623107/all/Chapter_186:_Parkinson’s_Disease.
Chapter 186: Parkinson’s Disease. In: Kasper DLD, Fauci ASA, Hauser SLS, et al, eds. Harrison's Manual of Medicine. McGraw Hill Inc.; 2020. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623107/all/Chapter_186:_Parkinson’s_Disease. Accessed December 2, 2024.
Chapter 186: Parkinson’s Disease. (2020). In Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L., Jameson, J. L., & Loscalzo, J. (Eds.), Harrison's Manual of Medicine (20th ed.). McGraw Hill Inc.. https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623107/all/Chapter_186:_Parkinson’s_Disease
Chapter 186: Parkinson’s Disease [Internet]. In: Kasper DLD, Fauci ASA, Hauser SLS, Longo DLD, Jameson JLJ, Loscalzo JJ, editors. Harrison's Manual of Medicine. McGraw Hill Inc.; 2020. [cited 2024 December 02]. Available from: https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623107/all/Chapter_186:_Parkinson’s_Disease.
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