Clinician Consult on Parkinson Disease
Your question will be answered by:
William J. Weiner, MD
Professor of Neurology
Chair, Department of Neurology
Director, Maryland Parkinson's Disease and Movement Disorder Center
University of Maryland School of Medicine
Baltimore, MD
Answered Questions
10/20/2009 - Question 1. In elderly patients with tremor, what are some of the clinical approaches to differentiate between tremors due to Parkinson disease and those due to other causes such as essential tremor?
This is a common problem in clinical practice. The tremor in essential tremor is a kinetic(intention) tremor which is not present when the hands are at rest but becomes apparent with use of the hands--patients complain of having difficulty eating soup on a spoon or peas on a fork. This can be easily tested by asking the patient to do the finger to nose test in which the patient reaches for the examiners finger and then touches their nose. The tremor in Parkinson`s disease is a resting tremor. The tremor is present when the patients hands are fully resting in their lap or on a table and the hand begins to shake involuntarily. In fact when a patient with resting tremor is asked to do the finger to nose test the tremor almost always is markedly diminished.
10/20/2009 - Question 2. What types of things do you continue to look for in the follow-up of the patient initially diagnosed with Parkinson disease to ensure that the original diagnosis was correct?
Parkinson`s disease is a slowly progressive disorder which usually has a unilateral onset and an asymmetry in signs which persists. Red flags which may appear as you follow a patient originally thought to have PD include early onset of balance problems and falling, unresponsivness to levodopa, orthostatic hypotension, early appearance of erectile dysfunction and urinary dysfunction, lack of a resting tremor, early cognitive problems, and symmetrical findings.
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