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| Parkinson's Disease (PD) |
 | ICD-9 Codes:
 | 332.0 paralysis agitans
| 332.1 secondary parkinsonism |
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| slight male predominence, usually > 50 years
old, 5% < 40 years old |
| Incidence: prevalence of parkinsonian syndromes increases markedly with age
| 1% population > 50 years old |
| 14.9% at age 65-74 |
| 52.4% at age > 85 (NEJM 1996;334;71) |
| prevalence of idiopathic Parkinson's disease 128-168 per 100,000, after accounting high rate of erroneous diagnosis.
BMJ 2000 Jul 1;321(7252);21 |
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| At least 2 of the 4 cardinal signs:
| Bradykinesia: slowness of movement |
| Rigidity: stiffness |
| Tremor: resting more than kinetic |
| Postural instability |
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| Only 75% of clinical diagnoses of PD are confirmed at autopsy, the
cardinal signs can occur in conditions other than PD. |
| Hemiparesis, spasticity, autonomic dysfunction or early dementia
suggest the disorder may not be IPD. |
| Initial presentation - 70% tremor, 20% stiffness
or slowness of movement, 13% loss of dexterity or handwriting
disturbance (e.g. micrographia), 12% gait disturbance, 8% muscle
pain/cramps/aching, 1-5% other (depression, nervousness, psychiatric
disturbance, speech disturbances, drooling, dysphagia. |
| 20% have no tremor but need to consider other
diagnoses, especially supranuclear palsy. |
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| Idiopathic Parkinson's Disease (IPD) |
| IPD is more of a pathologic diagnosis |
| Asymmetry and resting tremor is more common in IPD than in the other
types of parkinsonian syndromes. |
| Pathological findings:
| depigmentation and neuronal loss in the substantia
nigra. |
| Lewy bodies: intraneuronal inclusion bodies |
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| Diagnostic work up |
| Lab tests: CBC, Chemistries, LFT's, and thyroid function tests. |
| If patient is under 50 yo: serum ceruloplasmin, 24 hr urine copper,
and a slit-lamp exam for Kayser-Fleisher rings to rule out Wilson's disease. |
| MRI of the head if there is any atypical feature. |
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| Parkinsonism in Neurodegenerative Disorders |
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| Secondary Parkinsonism |
| Vascular disease |
| Post-encephalitic |
| Post-traumatic |
| Hydrocephalus |
| Space occupying lesions |
| Drug or toxin induced parkinsonism
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| Treatment |
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| References & further reading |
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