How does the neurologist, geriatrician, or movement disorder specialist confirm the diagnosis of Parkinson’s Disease as a prelude or trigger to beginning pharmacologic therapy? What are the pathognomonic features of this disease state?
Parkinson's disease is still a clinical diagnosis though there are now emerging confirmatory testing. The clinical features of Parkinson's are going to be typically two out of three motor features. Tremor, brady Tunisia and rigidity. So you need two out of those three to make the diagnosis. Or you may want to see pre motor features or balance impairment. So typically five and you want to see three out of those five in terms of motor features. Tremors typically at rest. So that's not always a rule, typically asymmetrical one sided, but also that's not always the rule either. So generally tremor on one side more than the other british in asia, which is slowness of movement, typically on one side more than the other. And in addition to that, uh cog wheeling rigidity, which is kind of a typical type of rigidity we see in Parkinson's individuals, also typically on one side than the other. So the asymmetry is actually the feature of Parkinson's in many ways. Some patients with tremors that are bilateral. Oftentimes get misdiagnosed as essential tremor when they actually have Parkinson's disease. So we tend to look for a combination not just the tremor, but the characteristics of the tremor, possibly the asymmetry. The rest of the postural re emergent component of it, along with the company of possibly bradycardia and cog wheeling rigidly. So those are still the main motor features. Non motor features are helpful. Non motor features such as pre motor symptoms such as an as mia, which may go back anywhere from several years to maybe a few months prior to the onset of the motor symptoms. You may see an as mia. Constipation, ren behavioral disorder has been associated with the nuclear sympathies as well, and it's an important component as well. Some individuals may experience restless legs symptoms and even calf cramps as they're developing the symptoms of Parkinson's. There is, however, a split about a third of the individuals are what I call mixed type, which means have a mixture of bradycardia, rigidity and as well as tremor, A third of them are tremor predominant, which means the majority of the symptoms are tremor with a little bit of bradycardia and rigidity mixed in, and a third of them never have a tremor. They mostly have bradycardia and rigidity and those are the folks that don't come to the doctor as early on. Many of their symptoms get blamed on joint pains, arthritis, aging, many other factors until those symptoms advanced. But the tremor predominant patients tend to come in much sooner because they see that as a visible manifestation of something is going on and get help sooner. So they come to your attention much sooner
