Differences

Last edited on June 25, 2023

This shows you the differences between two versions of the page.

--- geri:parkinsons [on March 29, 2023]
psychdb ↷ Links adapted because of a move operation
+++ geri:parkinsons [on June 25, 2023]
psychdb [Differential Diagnosis]
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 {{INLINETOC}}
 ===== Primer =====
-**Parkinson's disease (PD)** is a progressive neurodegenerative disease. Although historically considered a motor disorder, there are many neuropsychiatric symptoms associated with the disease, and the majority of diagnoses will progress to [[geri:dementia:parkinsons|]].
+**Parkinson's disease (PD)** is a progressive neurodegenerative disease characterized by a loss of dopaminergic innervation in the basal ganglia leading to motor and non-motor symptoms. Although historically considered a motor disorder, there are many neuropsychiatric symptoms associated with the disease, and the majority of diagnoses will progress to [[geri:dementia:parkinsons|]].
 == Epidemiology ==
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 ===== Signs and Symptoms =====
 ==== Prodrome ====
-  * Often, patients may have prodromal symptoms that occur decades before the classic symptoms present. This includes [[sleep: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]]. Loss of smell (hyposmia) is an important preclinical sign of PD as well.[([[https://pubmed.ncbi.nlm.nih.gov/15293269/|Ponsen, M. M., Stoffers, D., Booij, J., van Eck‐Smit, B. L., Wolters, E. C., & Berendse, H. W. (2004). Idiopathic hyposmia as a preclinical sign of Parkinson's disease. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 56(2), 173-181.]])]
+  * Often, patients may have prodromal symptoms that occur decades before the classic symptoms present. The most common being [[sleep:parasomnias:2-rem-sleep-disorder:home|REM sleep behaviour disorder (RBD)]], autonomic dysfunction, [[sleep:breathing:1-osa|obstructive sleep apnea]], and late onset [[mood:1-depression:home|depression]].
+  * Loss of smell (hyposmia) can be an early sign of PD as well.[([[https://pubmed.ncbi.nlm.nih.gov/15293269/|Ponsen, M. M., Stoffers, D., Booij, J., van Eck‐Smit, B. L., Wolters, E. C., & Berendse, H. W. (2004). Idiopathic hyposmia as a preclinical sign of Parkinson's disease. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 56(2), 173-181.]])]
   * Early signs of Parkinson's may include:[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891710/|Fénelon, G., Soulas, T., Zenasni, F., & De Langavant, L. C. (2010). The changing face of Parkinson's disease‐associated psychosis: a cross‐sectional study based on the new NINDS‐NIMH criteria. Movement Disorders, 25(6), 763-766.]])]
     * Visual illusions (misinterpretations of a real external stimulus )
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 <WRAP half column>
 Many neurodegenerative disorders are on the differential diagnosis. These disorders may first present with neuropsychiatric symptoms, and patients may see a psychiatrist before any other specialist. A differential diagnosis for Parkinson's includes:
-  * **Vascular parkinsonism**
+  * **Vascular Parkinsonism (VP)**
     * This is a parkinsonian disorder temporally-related or associated with [[geri:stroke|ischemic cerebrovascular disease]], individuals will have the same symptoms as idiopathic PD, such as muscle stiffness, bradykinesia, and balance problems
+    * Generally, vascular parkinsonism has a poor response to L-dopa treatment compared to idiopathic PD
   * **[[geri:dementia:lewy-body|]]**
   * **[[cl:wilsons-disease|]]**
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   * **[[addictions:home|Substance use disorders]]** (e.g. - alcohol withdrawal)
   * **Brain lesions or mass effects**
-  * [[meds:antipsychotics:eps|**Medication-induced parkinsonism** (i.e. - extrapyramidal symptoms)]]
+  * **[[meds:antipsychotics:eps|Medication-induced parkinsonism (i.e. - extrapyramidal symptoms)]]**
     * In these cases of potential confounding effects from medications such as antipsychotics, the clinician should try to elicit a clear history if the Parkinsonian symptoms developed before or after the initiation of antipsychotics.
 </WRAP>