Parkinson's disease

doi:10.1136/bmj.39289.437454.AD

BMJ 2007;335:441-445 (1 September), doi:10.1136/bmj.39289.437454.AD

Clinical Review

Parkinson's disease

C E Clarke, professor of clinical neurology, University of Birmingham

Department of Neurology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH

c.e.clarke@bham.ac.uk

The first 150 words of the full text of this article appear below.

Summary points

• Parkinson's disease should be suspectedin someone with tremor, stiffness, slowness, balance problems,or gait disorders

• All patients with suspected Parkinson'sdisease should be referred untreated to a specialist in differentialdiagnosis and be reviewed regularly by the specialist for accuratediagnosis and treatment

• Much debate surrounds whichdrug class should be used as initial treatment for Parkinson'sdisease and which adjuvant therapy should be added when patientstaking levodopa develop motor complications

• Patientsshould have access to a Parkinson's disease nurse specialistand allied health professionals throughout the course of thedisease

Tremor, often combined with slowness and stiffness in an arm,presents frequently in general practice. It may be caused byessential tremor, which affects 2-3% of the population.¹ Parkinson'sdisease is less common (prevalence 0.2%), although its prevalence increases with age (4% of those aged over 80 years).² Differentiatingessential tremor from Parkinson's . . . [Full text of this article]

How does Parkinson's disease present?

What conditions can it be confused with?

Box 1 Common causes of tremor
Rest tremor
Postural and action tremor
Intentiontremor
Box 2 Common causes of a parkinsonian syndrome

How is it diagnosed?

How should the early stages of the disease be treated?

How should the motor complications of the disease be treated?

How should more advanced disease be treated?

When should surgery be considered in advanced disease?

What are the non-motor features of the disease?

Box 3 Common non-motor features of Parkinson's disease

What nursing and allied health professional interventions are effective in the disease?

Box 4 Roles of allied health professional interventions in Parkinson'sdisease³
Physiotherapy
Occupational therapy
Speechand language therapy

What treatments can we expect in the near future?

Sources and selection criteria
Additional educational resources
Resources for healthcareprofessionals
Resources for patients

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