- Last edited on June 25, 2023
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geri:parkinsons [on May 16, 2019] |
geri:parkinsons [on June 2, 2019] |
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| ===== Symptoms ===== | ===== Symptoms ===== | ||
| == Prodrome == | == Prodrome == | ||
| - | Often, patients may have prodromal symptoms that occur decades before the classic symptoms present. This includes [[sleep:parasomnias:rls|restless legs]], [[sleep:parasomnias:rem-sleep-disorder:home|REM sleep behaviour disorders]] (always think about Parkinson's or Lewy Body Dementia in the patients!), autonomic dysfunction, [[sleep:breathing:1-osa|obstructive sleep apnea]], and late onset [[mood:1-depression:home|depression]]. | + | Often, patients may have prodromal symptoms that occur decades before the classic symptoms present. This includes [[sleep:parasomnias:rls|restless legs]], [[sleep:parasomnias:2-rem-sleep-disorder:home|REM sleep behaviour disorders]] (always think about Parkinson's or Lewy Body Dementia in the patients!), autonomic dysfunction, [[sleep:breathing:1-osa|obstructive sleep apnea]], and late onset [[mood:1-depression:home|depression]]. |
| == Classic Motor == | == Classic Motor == | ||
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| <panel type="danger" title="Absolute Exclusion Criteria" no-body="true"> | <panel type="danger" title="Absolute Exclusion Criteria" no-body="true"> | ||
| ^ The presence of //any// of these features rules out PD ^ | ^ The presence of //any// of these features rules out PD ^ | ||
| - | | 1. Unequivocal cerebellar abnormalities, such as cerebellar gait, limb ataxia, or cerebellar oculomotor abnormalities (e.g. - sustained gaze evoked nystagmus, macro square wave jerks, hypermetric saccades) \\ \\ 2. Downward vertical supranuclear gaze palsy, or selective slowing of downward vertical saccades \\ \\ 3. Diagnosis of probable behavioral variant [[geri:dementia:frontotemporal|frontotemporal dementia]] or [[geri:dementia:ppa|primary progressive aphasia]], defined according to consensus criteriamwithin the first 5 years of disease \\ \\ 4. Parkinsonian features restricted to the lower limbs for more than 3 years \\ \\ 5. Treatment with a dopamine receptor blocker (e.g. - antipsychotic) or a dopamine-depleting agent in a dose and time-course consistent with drug-induced parkinsonism \\ \\ 6. Absence of observable response to high-dose levodopa despite at least moderate severity of disease \\ \\ 7. Unequivocal cortical sensory loss (i.e. - graphesthesia, stereognosis with intact primary sensory modalities), clear limb ideomotor apraxia, or progressive aphasia \\ \\ 8. Normal functional neuroimaging of the presynaptic dopaminergic system \\ \\ 9. Documentation of an alternative condition known to produce parkinsonism and plausibly connected to the patient’s symptoms, or, the expert evaluating physician, based on the full diagnostic assessment feels that an alternative syndrome is more likely than PD | | + | | 1. Unequivocal cerebellar abnormalities, such as cerebellar gait, limb ataxia, or cerebellar oculomotor abnormalities (e.g. - sustained gaze evoked nystagmus, macro square wave jerks, hypermetric saccades) \\ \\ 2. Downward vertical supranuclear gaze palsy, or selective slowing of downward vertical saccades \\ \\ 3. Diagnosis of probable behavioral variant [[geri:dementia:frontotemporal|frontotemporal dementia]] or [[geri:dementia:primary-progressive-aphasia-ppa|primary progressive aphasia]], defined according to consensus criteriamwithin the first 5 years of disease \\ \\ 4. Parkinsonian features restricted to the lower limbs for more than 3 years \\ \\ 5. Treatment with a dopamine receptor blocker (e.g. - antipsychotic) or a dopamine-depleting agent in a dose and time-course consistent with drug-induced parkinsonism \\ \\ 6. Absence of observable response to high-dose levodopa despite at least moderate severity of disease \\ \\ 7. Unequivocal cortical sensory loss (i.e. - graphesthesia, stereognosis with intact primary sensory modalities), clear limb ideomotor apraxia, or progressive aphasia \\ \\ 8. Normal functional neuroimaging of the presynaptic dopaminergic system \\ \\ 9. Documentation of an alternative condition known to produce parkinsonism and plausibly connected to the patient’s symptoms, or, the expert evaluating physician, based on the full diagnostic assessment feels that an alternative syndrome is more likely than PD | |
| </panel> | </panel> | ||
| </WRAP> | </WRAP> | ||