The Parkinson's-Reversing Breakthrough
Major signs are resting tremor, rigidity, akinesia, and postural instability (2). Advanced PD rarely presents a diagnostic problem, but careful medical history and clinical examination is necessary at an early stage of a parkinsonian syndrome and in very old patients, especially because of other superimposed neurological or non-neurological disturbances (vascular lesions, musculoskeletal disease, vision and auditory problems).
Interview of Patient and Spouse or Family
- Lack of spontaneous gestures and smiling commented on by the family.
- Slowing of activities of daily living with increase in the length of time needed to get up and to get dressed, difficulties using the involved hand (buttons, toothbrush, lack of dexterity), slowness of gait, dragging of the involved leg, stooped posture; and insidious, and progressive and mistaken by the patient as related to "normal aging."
- Difficulties in sports (altered tennis and golf swing, lack of coordination while swimming).
- Micrographia and slowness of handwriting (the size of the handwriting progressively decreases after a few words or sentences in patients with PD; there is a fast micrographia with small letters from the beginning in PSP patients).
- Uncomfortable sensation of fatigue, tightness, stiffness of the limbs.
From: Current Clinical Neurology: Atypical Parkinsonian Disorders Edited by: I. Litvan © Humana Press Inc., Totowa, NJ
- Mild depression and withdrawal.
- Resting tremor when sitting in an armchair or while walking.
- Miscellaneous: profuse sweating or dry skin; sleep disturbances; daytime sleepiness; pain, numbness, or tingling in the limbs; shoulder arthralgia; radiculopathy.
In all cases, the examiner has to obtain a complete drug history as drug-induced parkinsonism and PD can present with the same clinical signs.
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