Assessment Of Parkinsonism

Question 1

Introduction

Answer 1

Usual shpiel

Ask about pain anywhere

Question 2

Inspection

Answer 2

Mobility aids
Any obvious tremor- fine or coarse
A Parkinsonism tremor is characteristically a unilateral coarse pill rolling tremor with a frequency of 4-6 Hz
Hypominima (reduced facial expression) or reduced blinking rate

Question 3

Tremor

Answer 3

Resting tremor- Parkinson tremor exacerbated by distraction (close eyes and count backwards from 20 or recite months of year backwards)

Postural tremor- assess with hands outstretched

Action tremor- move their finger from your hand to their nose (both hands). Can also pick up a glass of water/ take pen lid out of my hand etc.

Bradykinesia- spread index finger and thumb, then tap together as quick as possible (both hands).

Question 4

Rigidity

Answer 4

Tone- test as you normally would in a neuro exam (looking for increased tone and cogwheeling (rigidity in presence of tremor)

Synkinesis- if no rigidity appreciated, test again using synkinesis (get contralateral limb to do an action eg. Tapping knee up and down or doing the thumb/index finger assessment)

Question 5

Other parts of neuro exam

Answer 5

Power reflexes and sensation- not usually performed. Should be normal in PD. Only performed if indicated by the history.

Gait- ensure patient is safe to do so eg. Mobility aids etc.

• small steps
• postural instability
• bradykinesia
• stooped posture (camptocormia)
• difficulty imitating steps
• short shuffling steps
• reduced or absent arm swing
• festination (speeding up and shortening of step length)
• difficulty turning
• freezing phenomenon (doorways/ patterned carpets/ misc. obstacles)
• pull test

Eye movements- as you would with cranial nerves. Vertical gaze palsy (PSP) and nystagmus (cerebellum)

Speech- hypophonia. Dysarthria and staccato speech (cerebellar pathology)

Question 6

Other tests

Answer 6

Lying and standing blood pressure

Writing- micrographia

Formal cognition test