Parkinson's disease physical examination: Difference between revisions
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==Physical Examination== | ==Physical Examination== | ||
===Appearance=== | ===Appearance=== | ||
In the appearance of [[Parkinson's disease|PD]] patients we can notice that the [[blinking]] rate of spontaneous blinking is lower than normal but voluntary blinking is similar to general population.<ref name="pmid18175339">{{cite journal |vauthors=Agostino R, Bologna M, Dinapoli L, Gregori B, Fabbrini G, Accornero N, Berardelli A |title=Voluntary, spontaneous, and reflex blinking in Parkinson's disease |journal=Mov. Disord. |volume=23 |issue=5 |pages=669–75 |date=April 2008 |pmid=18175339 |doi=10.1002/mds.21887 |url=}}</ref> The other finding in [[Parkinson's disease|PD]] patient is that their spontaneous [[Facial expression|facial expressions]] are less frequent and less varied in comparison to normal people ([[hypomimia]]).<ref name="pmid24524211">{{cite journal |vauthors=Dumer AI, Oster H, McCabe D, Rabin LA, Spielman JL, Ramig LO, Borod JC |title=Effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on hypomimia in Parkinson's disease |journal=J Int Neuropsychol Soc |volume=20 |issue=3 |pages=302–12 |date=March 2014 |pmid=24524211 |doi=10.1017/S1355617714000046 |url=}}</ref> | * In the appearance of [[Parkinson's disease|PD]] patients we can notice that the [[blinking]] rate of spontaneous blinking is lower than normal but voluntary blinking is similar to general population.<ref name="pmid18175339">{{cite journal |vauthors=Agostino R, Bologna M, Dinapoli L, Gregori B, Fabbrini G, Accornero N, Berardelli A |title=Voluntary, spontaneous, and reflex blinking in Parkinson's disease |journal=Mov. Disord. |volume=23 |issue=5 |pages=669–75 |date=April 2008 |pmid=18175339 |doi=10.1002/mds.21887 |url=}}</ref> The other finding in [[Parkinson's disease|PD]] patient is that their spontaneous [[Facial expression|facial expressions]] are less frequent and less varied in comparison to normal people ([[hypomimia]]).<ref name="pmid24524211">{{cite journal |vauthors=Dumer AI, Oster H, McCabe D, Rabin LA, Spielman JL, Ramig LO, Borod JC |title=Effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on hypomimia in Parkinson's disease |journal=J Int Neuropsychol Soc |volume=20 |issue=3 |pages=302–12 |date=March 2014 |pmid=24524211 |doi=10.1017/S1355617714000046 |url=}}</ref> | ||
===Neuromascular=== | ===Neuromascular=== | ||
* Cogwheel rigidity: when we want to move the patient's [[joint]] passively, there is a ratchety pattern of resistance and relaxation and overally there is a higher resistance against our passive move.<ref name="pmid9827589">{{cite journal |vauthors=Deuschl G, Bain P, Brin M |title=Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee |journal=Mov. Disord. |volume=13 Suppl 3 |issue= |pages=2–23 |date=1998 |pmid=9827589 |doi= |url=}}</ref><ref name="pmid13928399">{{cite journal |vauthors=LANCE JW, SCHWAB RS, PETERSON EA |title=Action tremor and the cogwheel phenomenon in Parkinson's disease |journal=Brain |volume=86 |issue= |pages=95–110 |date=March 1963 |pmid=13928399 |doi= |url=}}</ref> | * Cogwheel rigidity: when we want to move the patient's [[joint]] passively, there is a ratchety pattern of resistance and relaxation and overally there is a higher resistance against our passive move.<ref name="pmid9827589">{{cite journal |vauthors=Deuschl G, Bain P, Brin M |title=Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee |journal=Mov. Disord. |volume=13 Suppl 3 |issue= |pages=2–23 |date=1998 |pmid=9827589 |doi= |url=}}</ref><ref name="pmid13928399">{{cite journal |vauthors=LANCE JW, SCHWAB RS, PETERSON EA |title=Action tremor and the cogwheel phenomenon in Parkinson's disease |journal=Brain |volume=86 |issue= |pages=95–110 |date=March 1963 |pmid=13928399 |doi= |url=}}</ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Physical Examination
Appearance
- In the appearance of PD patients we can notice that the blinking rate of spontaneous blinking is lower than normal but voluntary blinking is similar to general population.[1] The other finding in PD patient is that their spontaneous facial expressions are less frequent and less varied in comparison to normal people (hypomimia).[2]
Neuromascular
- Cogwheel rigidity: when we want to move the patient's joint passively, there is a ratchety pattern of resistance and relaxation and overally there is a higher resistance against our passive move.[3][4]
- Resting tremor: we ask the patient to relax his/her arms and start talking about something else to distract him/her. we can see that there is resting tremor unilaterally or bilateraly with higher severity in one side.[5]
- Gait problems: PD patients have balance and gait problems ( shuffling gait)[6]
- Bradykinesia: these patients have slow movements in examinations.[7]
- Olfactory dysfunction: Deficits in odor identification and discrimination are common in PD[8]
- Orthostatic hypotension: Orthostatic hypotension can be seen in PD patients due to autonomic dysfunction.[9]
References
- ↑ Agostino R, Bologna M, Dinapoli L, Gregori B, Fabbrini G, Accornero N, Berardelli A (April 2008). "Voluntary, spontaneous, and reflex blinking in Parkinson's disease". Mov. Disord. 23 (5): 669–75. doi:10.1002/mds.21887. PMID 18175339.
- ↑ Dumer AI, Oster H, McCabe D, Rabin LA, Spielman JL, Ramig LO, Borod JC (March 2014). "Effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on hypomimia in Parkinson's disease". J Int Neuropsychol Soc. 20 (3): 302–12. doi:10.1017/S1355617714000046. PMID 24524211.
- ↑ Deuschl G, Bain P, Brin M (1998). "Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee". Mov. Disord. 13 Suppl 3: 2–23. PMID 9827589.
- ↑ LANCE JW, SCHWAB RS, PETERSON EA (March 1963). "Action tremor and the cogwheel phenomenon in Parkinson's disease". Brain. 86: 95–110. PMID 13928399.
- ↑ Scott RM, Brody JA, Schwab RS, Cooper IS (July 1970). "Progression of unilateral tremor and rigidity in Parkinson's disease". Neurology. 20 (7): 710–4. PMID 5463541.
- ↑ Koller WC, Glatt S, Vetere-Overfield B, Hassanein R (April 1989). "Falls and Parkinson's disease". Clin Neuropharmacol. 12 (2): 98–105. PMID 2720700.
- ↑ Pagano G, Ferrara N, Brooks DJ, Pavese N (April 2016). "Age at onset and Parkinson disease phenotype". Neurology. 86 (15): 1400–7. doi:10.1212/WNL.0000000000002461. PMC 4831034. PMID 26865518.
- ↑ Tissingh G, Berendse HW, Bergmans P, DeWaard R, Drukarch B, Stoof JC, Wolters EC (January 2001). "Loss of olfaction in de novo and treated Parkinson's disease: possible implications for early diagnosis". Mov. Disord. 16 (1): 41–6. PMID 11215591.
- ↑ Verbaan D, Marinus J, Visser M, van Rooden SM, Stiggelbout AM, van Hilten JJ (July 2007). "Patient-reported autonomic symptoms in Parkinson disease". Neurology. 69 (4): 333–41. doi:10.1212/01.wnl.0000266593.50534.e8. PMID 17646625.