RT Book, Section
A1 Kasper, Dennis L.
A1 Fauci, Anthony S.
A1 Hauser, Stephen L.
A1 Longo, Dan L.
A1 Jameson, J. Larry
A1 Loscalzo, Joseph
SR Print(0)
ID 1128788097
T1 Parkinson's Disease
T2 Harrison's Manual of Medicine, 19e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9780071828529
LK accessmedicine.mhmedical.com/content.aspx?aid=1128788097
RD 2024/04/23
AB Parkinsonism  is  a  general  term  used  to  define  a  syndrome  manifest  as  bradykinesia  (slowness  of  voluntary  movements)  with  rigidity  and/or  tremor;  it  has  a  wide  differential  diagnosis  (Table  183-1).  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.