Diagnosis of Parkinson Disease

●  When seeing an older patient with mild, unilateral rest tremor, what other signs should the clinician look for in helping to make a diagnosis of Parkinson disease?

●  How do you test for postural instability in the patient suspected of having Parkinson disease and what is considered abnormal?

●  Once the clinical diagnosis of Parkinson disease is made, is the next step brain imaging with an MRI or CT scan?

●  What is the role of the levodopa challenge in making the diagnosis of early Parkinson disease?

●  Once the diagnosis of Parkinson disease is made, how is this diagnosis communicated to the patient?

●  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?

●  Is the use of modest alcohol consumption a useful approach in differentiating essential tremor from tremor associated with Parkinson disease?

●  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?

●  Are repeated instances of falling commonly seen in the first year in patients diagnosed with Parkinson disease?

●  Why is it important to look for eye movement abnormalities in the first year?

●  How useful to primary care physicians is olfactory testing in the diagnosis of Parkinson disease?

●  How does the clinician distinguish between drug-induced parkinsonism and Parkinson disease?

●  What are some of the more common drugs that can cause drug-induced parkinsonism in the primary care setting?

Depression (Nonmotor Manifestations of Parkinson Disease)

●  How common is depression in patients with Parkinson disease?

●  What is the impact of depression on the motor manifestations of Parkinson disease?

●  What antidepressant agents are used to treat Parkinson disease?

Dementia (Nonmotor Manifestations of Parkinson Disease)

●  How common is dementia in patients with Parkinson disease?

●  What is the difference between dementia in Parkinson disease and dementia with Lewy bodies?

●  What is the clinical distinction between Parkinson disease dementia and Alzheimer disease?

●  What screening tool can be used by the clinician in making the diagnosis of dementia in the Parkinson disease patient?

●  What medications can be used to treat dementia in Parkinson disease patients?

Sleep dysfunction and daytime somnolence(Nonmotor Manifestations of Parkinson Disease)

●  How common is sleep dysfunction and daytime somnolence in the Parkinson disease patient?

●  Is the sleep dysfunction seen in Parkinson disease related to the medications?

●  How should the clinician approach the problem of daytime somnolence?

●  What is REM behavior disorder in Parkinson patients?

●  Are there medications that might be considered to counteract daytime somnolence in the Parkinson patient?

Autonomic dysfunction(Nonmotor Manifestations of Parkinson Disease)

●  How common are autonomic dysfunctions in Parkinson disease?

●  How is nausea managed in the Parkinson patient?

●  What is the role of physical activity and physical therapy in managing Parkinson disease?