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Practice Essentials

Parkinson disease (PD) is one of the most common neurologic disorders, affecting approximately 1% of individuals older than 60 years and causing progressive disability that can be slowed, but not halted, by treatment. The 2 major neuropathologic findings in Parkinson disease are loss of pigmented dopaminergic neurons of the substantia nigra pars compacta and the presence of Lewy bodies and Lewy neurites.

Essential update: Ioflupane plus123 I and SPECT scanning may improve diagnosis of early-stage Parkinson Disease
Analysis of data from 2 clinical trials demonstrated that use of the contrast agent ioflupane with iodine-123 and single-photon emission computed tomography (SPECT) scanning to diagnose early-stage Parkinson's disease performed as well as clinical assessment at 1-year follow-up.[1, 2] In one of the studies consisting of images from 179 people with early characteristics of Parkinson syndrome, specificity (95.4%) and positive predictive value (95.8%) were better for the baseline imaging diagnosis than for baseline clinical diagnosis (52.4% and 69.7%, respectively). Moreover, specificity (92%), positive predictive value (93%), and negative predictive value (98%) were better for 4-week clinical diagnosis (after imaging results became available) than the baseline clinical diagnosis (48%, 65%, and 72%, respectively). These findings remained better for 12-week and 1-year clinical diagnoses.[1, 2]

Signs and symptoms

Initial clinical symptoms of Parkinson disease include the following:

Tremor Subtle decrease in dexterity Decreased arm swing on the first-involved side Soft voice Decreased facial expression Sleep disturbances Rapid eye movement (REM) behavior disorder (RBD; a loss of normal atonia during REM sleep) Decreased sense of smell Symptoms of autonomic dysfunction (eg, constipation, sweating abnormalities, sexual dysfunction, seborrheic dermatitis) A general feeling of weakness, malaise, or lassitude Depression or anhedonia Slowness in thinking

Onset of motor signs include the following:

Typically asymmetric The most common initial finding is a resting tremor in an upper extremity

Over time, patients experience progressive bradykinesia, rigidity, and gait difficulty Axial posture becomes progressively flexed and strides become shorter Postural instability (balance impairment) is a late phenomenon

Nonmotor symptoms Nonmotor symptoms are common in early Parkinson disease. Recognition of the combination of nonmotor and motor symptoms can promote early diagnosis and thus early intervention, which often results in a better quality of life. See Clinical Presentation for more detail.

Parkinson disease is a clinical diagnosis. No laboratory biomarkers exist for the condition, and findings on routine magnetic resonance imaging and computed tomography scans are unremarkable. Clinical diagnosis requires the presence of 2 of 3 cardinal signs:

Resting tremor Rigidity Bradykinesia

See Workup for more detail.

The goal of medical management of Parkinson disease is to provide control of signs and symptoms for as long as possible while minimizing adverse effects. Symptomatic drug therapy

Usually provides good control of motor signs of Parkinson disease for 4-6 years Levodopa/carbidopa: The gold standard of symptomatic treatment Monoamine oxidase (MAO)B inhibitors: Can be considered for initial treatment of early disease Other dopamine agonists (eg, ropinirole, pramipexole): Monotherapy in early disease and adjunctive therapy in moderate to advanced disease Anticholinergic agents (eg, trihexyphenidyl, benztropine): Second-line drugs for tremor only

Treatment for nonmotor symptoms

Sildenafil citrate (Viagra): For erectile dysfunction Polyethylene glycol: For constipation

Modafinil: For excessive daytime somnolence Methylphenidate: For fatigue (potential for abuse and addiction)

Deep brain stimulation

Surgical procedure of choice for Parkinson disease Does not involve destruction of brain tissue Reversible Can be adjusted as the disease progresses or adverse events occur Bilateral procedures can be performed without a significant increase in adverse events

Parkinson's Disease Definition and Overview

Parkinson's disease (PD) is an age-related progressive deterioration of certain nerve systems in the brain, which affects movement, balance, and muscle control.

Parkinson's disease is one of the most common movement disorders, affecting about 1% of people older than 60 years. PD is about 1.5 times more common in men than in women, and it becomes more likely to occur in people as they age. PD is not a hereditary disease. The average age of onset is about 60 years. Onset before age 40 years is relatively uncommon, but the much-publicized diagnosis of actor Michael J. Fox shows that younger people are also vulnerable. In PD, brain cells deteriorate (or degenerate) in an area of the brain called the substantia nigra. From the substantia nigra, specific nerve cell tracts connect to another part of the brain called the corpus striatum, where the neurotransmitter (a chemical messenger in the brain) called dopamine is released. Dopamine is an important neurotransmitter and alterations in its concentration can lead to the different medical problems seen in PD. The loss of these specific brain cells and decline in dopamine concentration are key steps that lead to the signs and symptoms of PD as well as are the target for treatments of PD. However, the biological, chemical, and genetic mechanisms responsible for the brain cell loss have not been identified with certainty. verview