Parkinson's Disease Examination

Introduction0/5

• Greetings
• Hand wash
• Verify the patient's identity using at least two or three details
• Explanation
• Consent

Inspection0/3

• Overall wellnessAssess if patient appears well or unwell
• Note on limb weakness / tremor or extra movements
• Note any walking aids

While standing up0/11

• Gait (Assess by asking patient to walk in straight line, turn and walk back again and stop)
  • If patient uses walking aid → ask if it is safe to walk with or without aids
  • Assess for reduced arm swing
  • Shuffling gait
  • Destination
  • See if more steps taken on turning
  • Imbalance
  • Drift
  • Assess for festination
• Assess retropulsionPull patient backwards from the shoulders. Assess for inability to maintain balance. Stand behind patient to catch them if they lose balance.
• Timed get up and go

Face0/5

• Look for facial expression or mask like facies
• Head titubation
• Look for drooling or excess salivationMay be due to bradykinesia
• Assess for glabellar tapPositive when ongoing blink response to tapping
• Assess eye movementsLoss of vertical gaze, predominantly upwards suggestive of Idiopathic Parkinson's. Loss of vertical and lateral gaze suggests PSP (Progressive Supranuclear Palsy).

Upper limb0/4

• Assess for tremor (Pill rolling tremor / Resting tremor / Intention tremor)Check if tremor increases with distraction or decreases with intention
• Ask to do nose to finger test for intention tremor
• Test for fine motor (Tap on table like piano)Assesses bradykinesia
• Assess for tone in upper limbCheck for cogwheeling, lead pipe rigidity

Speech0/2

• Is the patient's speech monotonous and quiet? Any signs of palilalia (repeating word endings)?
• Assess for micrographiaAsk patient to write a sentence and assess for small handwriting

Parkinson's Plus symptoms0/1

• Check for autonomic dysfunction (lying and standing BP)

Ask about0/2

• Falls
• Bowel movement

• Say you would do an MMSE for dementia
• Wash hands