• Parkinson’s Disease

    Parkinson’s Disease - banner - بیماری پارکینسون

Parkinson’s Disease

What is Parkinson Disease (PD)?

  • Parkinson disease (PD) is caused by a disruptionParkinson’s Disease - img1 of dopaminergic neurotransmission in the basal ganglia and development of eosinophilic inclusions (Lewy bodies) in the residual neurons.
  • Genetic predisposition: May present; up to 15% of patients have a first- or second-degree relative with Parkinson disease.
  • No clear environmental links to the disease identified.


  • In US
    • Parkinson disease is the second most common progressive neurodegenerative disorder after Alzheimer disease.
    • Parkinson affects about 1% of the population older than age 60 years
      • 4% to 5% of those older than 85 yearsParkinson’s Disease - img2
  • In Australia
    • Prevalence: 120–150 per 100 000
    • Lifetime risk is 1 in 40
    • Mean age of onset: Between 58 and 62 years.

Clinical Features

The hallmark clinical features of Parkinson disease (usually asymmetric onset) include

  • Tremor
    • Presenting symptom in up to 70% of patients.
    • Asymmetric rest tremor is virtually pathognomonic of Parkinson disease.
    • Differential Diagnosis: essential tremor
      • Usually symmetric
      • Exacerbated by action
  • Rigidity: Cog wheeling quality during passive movement of the limb
  • Bradykinesia:Parkinson’s Disease - img3
    • Refers to the slowness of movements
    • Usually begins in an asymmetric fashion
    • Described by the patient as “weakness” of an extremity
      • Strength testing: Normal
    • Difficulty with fine finger tasks
    • Micrographia
    • Paucity of facial expression (masked face)
    • Lack of blinking
    • Excessive salivation (late stages)
    • Swallowing problems
    • Soft, slow monotonous speech

Other clinical features associated with Parkinson disease include

  • General presentations:
    • Tiredness
    • Lethargy
    • Restlessness
    • Trouble getting out of chair or car and turning over in bed
  • Gait disorderParkinson’s Disease - img4
    • Start hesitation
    • Festination
    • No arm swing on one or both sides
    • Slow and narrow based gait
    • Short steps (petit pas)
    • Slow turning circle (‘turn by numbers’)
    • ‘Freezing’ when approaching an obstacle
    • Poor balance
  • Posture
    • Progressive forward flexion of trunk (stooped)
    • Flexion of elbow at affected side
  • Autonomic symptoms
    • Constipation: common
    • Postural hypotension: may be induced by treatmentParkinson’s Disease - img5
  • Neuropsychiatric
    • Depression (early stages)
    • Anxiety
    • Sleep disorder
    • Progressive dementia in 30–40% usually after 10 years.
    • Hallucinations
  • Reduced sense of smell: One of the first symptoms
  • Think of PD in an older person presenting with falls


  • Based on the history and examination (it is a clinical diagnosis)parkinson diagnosis
  • There is no laboratory test for PD
    • Differential diagnosis include hypothyroidism and depression
  • Drug-induced Parkinsonism:
    • Common drugs: phenothiazines, butyrophenones and reserpine.
    • Tremor is uncommon
    • Rigidity and bradykinesia may be severe.


Parkinsons Management

  • Pharmacotherapy
  • Surgical treatment
  • Treatment of Non-motor Symptoms

Recent Studies Show