Parkinson Disease Questions & Answers

Updated: Aug 29, 2019
  • Author: Robert A Hauser, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Questions & Answers

Overview

Which major neurological findings are characteristic of Parkinson disease (PD)?

Why is it important to recognize both motor and nonmotor symptoms in patients with suspected Parkinson disease (PD)?

What are the initial clinical symptoms of Parkinson disease (PD)?

What are the initial motor signs of Parkinson disease (PD)?

What are the diagnostic criteria for Parkinson disease (PD)?

What is the goal of medical management of Parkinson disease (PD)?

Which medications are used to control symptoms of Parkinson disease (PD)?

Which medications are used to control the nonmotor symptoms of Parkinson disease (PD)?

What is deep brain stimulation for Parkinson disease (PD)?

What causes Parkinson disease (PD)?

What are the three motor signs of Parkinson disease (PD)?

What causes of tremor should be considered in the differential diagnoses of Parkinson disease (PD)?

How is a diagnosis confirmed in patients with a typical Parkinson disease (PD) presentation?

When are imaging studies considered in the diagnosis of Parkinson disease (PD)?

Which medications are used to control the motor symptoms of Parkinson disease (PD)?

What part of the brain is affected by Parkinson disease (PD)?

What are the neuropathologic findings of Parkinson disease (PD)?

How does Parkinson disease (PD) affect the basal ganglia motor circuit?

What is the etiology of Parkinson disease (PD)?

Which environmental risk factors may increase the risk of developing Parkinson disease (PD)?

Does exposure to pesticides, herbicides, or other pollutants increase the risk of developing Parkinson disease (PD)?

Does high caffeine intake or smoking increase the risk of developing Parkinson disease (PD)?

Does 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) cause Parkinson disease (PD)?

What is the oxidation hypothesis of the etiology of Parkinson disease (PD)?

What is the role of genetic factors in the development of Parkinson disease (PD)?

Which gene mutations may be related to Parkinson disease (PD)?

Which genetic mechanisms are thought to cause Parkinson disease (PD)?

What is the role of alpha-synuclein in the pathogenesis of Parkinson disease (PD)?

What is the relationship between melanoma and Parkinson disease (PD)?

What is the incidence of Parkinson disease (PD)?

How does the incidence of Parkinson disease (PD) change with age, and are men and women equally affected?

What is the impact of levodopa treatment on the prognosis and mortality rate of Parkinson disease (PD)?

What factors are predictive of the rate of progression of Parkinson disease (PD)?

What educational information should be given to patients with Parkinson disease (PD)?

Presentation

What are the initial physical findings of Parkinson disease (PD)?

Which nonmotor symptoms precede the motor signs of Parkinson disease (PD)?

What are the initial clinical symptoms of Parkinson disease (PD)?

What is the typical presentation of tremors due to Parkinson disease (PD)?

What is bradykinesia in patients with Parkinson disease (PD)?

What are the characteristics of facial bradykinesia in patients with Parkinson disease (PD)?

What are the characteristics of truncal bradykinesia in patients with Parkinson disease (PD)?

How does bradykinesia manifest in activities of daily life in patients with Parkinson disease (PD)?

What is cogwheel rigidity in patients with Parkinson disease (PD)?

How does dystonia present in patients with Parkinson disease (PD)?

What are the cardinal signs of Parkinson disease (PD)?

How is resting tremor assessed in a physical exam in patients with Parkinson Disease (PD)?

How is rigidity assessed in a physical exam in patients with Parkinson disease (PD)?

How is bradykinesia assessed in a physical exam in patients with Parkinson disease (PD)?

How is postural instability assessed in patients with Parkinson disease (PD)?

Which speech tendencies should be assessed in patients with Parkinson disease (PD)?

What are manifestations of dysphagia in patients with Parkinson disease (PD)?

How is laryngeal dysfunction assessed in patients with Parkinson disease (PD)?

What are characterizations of the Parkinson disease (PD) larynx?

What is the prevalence of vocal tremor in patients with Parkinson disease (PD)?

Is autonomic dysfunction common in patients with Parkinson disease (PD)?

Does prominent autonomic dysfunction suggest an alternative diagnosis to Parkinson disease (PD)?

Which cardiopulmonary impairments may be caused by Parkinson disease (PD)?

How is Parkinson disease (PD) severity assessed and staged?

How is depression assessed in patients with Parkinson disease (PD)?

Which assessment is most effective in screening for mild cognitive impairment or dementia in patients with Parkinson disease (PD)?

What is the prevalence of dementia in patients with Parkinson disease (PD)?

When in the course Parkinson disease (PD) does dementia or other cognitive impairment typically occur?

What are atypical parkinsonisms (Parkinson-plus syndromes)?

What is the prognosis of atypical parkinsonisms (Parkinson-plus syndromes)?

DDX

How is essential tremor differentiated from Parkinson disease (PD)?

Which secondary causes of parkinsonism (Parkinson-plus syndromes) should be considered in the differential diagnoses of Parkinson disease (PD)?

Does Parkinson disease (PD) increase the risk of osteoporosis and osteopenia?

Does Parkinson disease (PD) increase the risk of bone fracture?

What features differentiate an atypical parkinsonism (Parkinson-plus syndromes) from Parkinson disease (PD)?

How is Lewy body disease characterized in patients with parkinsonism?

When should Wilson disease be considered in patients with parkinsonism?

What are the differential diagnoses for Parkinson Disease?

Workup

Which lab studies are useful in the diagnosis of Parkinson disease (PD)?

Are any lab tests or imaging studies required for the diagnosis of Parkinson disease (PD)?

What tests may be indicated in patients with an unusual presentation of Parkinson disease (PD)?

How is Wilson disease screened for in the evaluation of patients with suspected Parkinson disease (PD)?

How is the clinical diagnosis of Parkinson disease (PD) confirmed?

Why is there a high diagnosis error rate between Parkinson disease (PD) and other movement disorders?

When is MRI indicated in the evaluation of patients with suspected Parkinson disease (PD)?

What is the role of PET scanning and SPECT in the evaluation of patients with Parkinson disease (PD)?

What are the usual histologic findings in Parkinson disease (PD)?

What histologic findings i Lewy bodies in patients with Parkinson disease (PD)?

What were the results of the Parkinson's Progression Markers Initiative (PPMI)?

When is lumbar puncture considered in the evaluation of patients with suspected Parkinson disease (PD)?

When should dopa-responsive dystonia be considered in the evaluation of Parkinson disease (PD)?

Treatment

What is the goal of medical management of Parkinson disease (PD)?

Are there neuroprotective (disease modifying) treatment options for Parkinson disease (PD)?

What is the role of levodopa in the management of Parkinson disease (PD)?

What is the role of monoamine oxidase (MAO)-B inhibitors in the management of Parkinson disease (PD)?

What is the role of dopamine agonists (ropinirole, pramipexole) in the treatment of Parkinson disease (PD)?

How long are medications effective in controlling the motor signs of Parkinson disease (PD)?

What is neuroprotective (disease modifying) therapy in the context of Parkinson disease (PD)?

How does the management of Parkinson disease (PD) differ in younger patients?

What are the indications for surgery in patients with Parkinson disease (PD)?

How are the nonmotor symptoms of Parkinson disease (PD) categorized?

What are the American Academy of Neurology (AAN) guidelines for the treatment of nonmotor symptoms of Parkinson disease (PD)?

Which medications are commonly used to control motor symptoms in early Parkinson disease (PD)?

What are the long-term risks of levodopa for the management of Parkinson disease (PD)?

What is the benefit of combining carbidopa with levodopa in the management of Parkinson disease (PD)?

What are the available preparations of levodopa/carbidopa?

How is the combination of levodopa, carbidopa, and entacapone used in the management of Parkinson disease (PD)?

What is the recommended dosage for levodopa and a dopa decarboxylase inhibitor in the management of Parkinson disease (PD)?

What are the benefits of using MAO-B inhibitors (selegiline and rasagiline) in the treatment of Parkinson disease (PD)?

When are selegiline and rasagiline indicated in the treatment of Parkinson disease (PD)?

How effective are dopamine agonists in the treatment of Parkinson disease (PD)?

Should dopamine agonists be used in the treatment of Parkinson disease (PD) in patients older than 65 years?

What dosage is recommended for the introduction of a dopamine agonist in the treatment of Parkinson disease (PD)?

What are the adverse effects of dopamine agonists?

When are anticholinergic medications indicated in the treatment of Parkinson disease (PD)?

How effective are anticholinergic agents in the treatment of Parkinson disease (PD)?

What are the possible adverse effects of anticholinergic agents in patients with Parkinson disease (PD)?

What are the recommended dosages of anticholinergic agents in the treatment of Parkinson disease (PD)?

What is amantadine’s mechanism of action in controlling parkinsonian activity?

What is the recommended dosage for amantadine in the treatment of Parkinson disease (PD)?

What are the potential adverse effects of amantadine?

Does amantadine increase or decrease impulse control disorders in patients with Parkinson disease (PD)?

Which drugs reduce dyskinesis in patients with Parkinson disease (PD)?

Does the benefit of levodopa for the management of Parkinson disease (PD) decrease over time?

What options are available to provide more sustained dopaminergic therapy in patients with Parkinson disease (PD)?

How effective is carbidopa/levodopa enteral suspension (Duopa) in increasing the benefit of levodopa in the treatment of Parkinson disease (PD)?

How effective is safinamide (Xadago) in in increasing the benefit of levodopa in the management of Parkinson disease (PD)?

When should dopaminergic therapy be increased to eliminate off-time in patients with Parkinson disease (PD)?

What is peak-dose dyskinesia in patients with Parkinson disease (PD)?

Is it safe to continue increasing dosage of levodopa if the patient develops dyskinesia?

What is the goal of treating patients with Parkinson disease (PD) who experience both motor fluctuation and peak-dose dyskinesia?

What is the benefit of switching from levodopa/carbidopa CR to levodopa/carbidopa IR in the treatment of Parkinson disease (PD)?

What is the role of COMT inhibitors in the treatment of Parkinson disease (PD)?

Are dopamine agonists beneficial in the management of Parkinson disease (PD) patients with both motor fluctuation and peak-dose dyskinesia?

What are the potential adverse effects of amantadine?

Are there any surgical options for patients with Parkinson disease (PD) who have both motor fluctuations and dyskinesia?

What are the treatment options for tremor in patients with Parkinson disease (PD)?

What is the role of laser shoes in reducing freezing episodes among patients with Parkinson disease (PD)?

Are any neuroprotective therapies available for Parkinson disease (PD)?

Does selegiline (Eldepryl, Zelapar) have neuroprotective effects in patients with Parkinson disease (PD)?

Does rasagiline (Azilect) have neuroprotective effects in patients with Parkinson disease (PD)?

What were the results of the TEMPO (Rasagiline in Early Monotherapy for Parkinson's Disease Outpatients) study?

What were the results of the ADAGIO (Attenuation of Disease progression with Azilect Given Once-daily) study?

What are the potential neuroprotective effects of levodopa therapy in early Parkinson disease (PD)?

What are the potential neuroprotective effects of dopamine agonists in Parkinson disease (PD)?

Why is deep brain stimulation (DBS) the surgical procedure of choice for Parkinson disease (PD)?

Which gray-matter structures are involved in deep brain stimulation (DBS) surgery for Parkinson disease (PD)?

What are the indications for deep brain stimulation (DBS) surgery in patients with Parkinson disease (PD)?

How are patients with Parkinson disease (PD) selected for deep brain stimulation (DBS)?

Is thalamic deep brain stimulation (DBS) indicated for patients with Parkinson disease (PD)?

How effective is subthalamic nucleus (STN) stimulation and globus pallidus interna (GPi) deep brain stimulation (DBS) in the management of Parkinson disease (PD)?

How effective is bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with Parkinson disease (PD)?

Is methylphenidate effective in improving gait disorders in patients with advanced Parkinson disease (PD)?

What is the long-term effectiveness of subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with Parkinson disease (PD)?

Is subthalamic nucleus (STN) deep brain stimulation (DBS) effective for treating pain related to Parkinson disease (PD)?

Does subthalamic nucleus (STN) deep brain stimulation (DBS) increase or decrease impulse control disorders in patients with Parkinson disease (PD)?

When are lesion surgeries indicated in the treatment of Parkinson disease (PD)?

Is thalamotomy effective in the treatment of Parkinson disease (PD)?

Is pallidotomy effective in the treatment of Parkinson disease (PD)?

What are the potential adverse effects of pallidotomy?

Is bilateral pallidotomy recommended in patients with Parkinson disease (PD)?

Is subthalamotomy effective in the treatment of Parkinson disease (PD)?

Which specialists should provide care for a patient undergoing surgical procedures for the treatment of Parkinson disease (PD)?

What is the patient evaluation and selection process for individuals with Parkinson disease (PD) considering subthalamic nucleus (STN) deep brain stimulation (DBS)?

After patient selection, what is the process for determining the correct surgical procedure for management of Parkinson disease (PD)?

What is the role of a psychiatrist in the preoperative evaluation of a patient with Parkinson disease (PD)?

When is a fluorodopa positron emission tomography (PET) scan indicated in the preoperative evaluation of patients with Parkinson disease (PD)?

When is surgery indicated in the treatment of Parkinson disease (PD)?

How is neural transplantation used in the treatment of Parkinson disease (PD)?

What are the effects of neural transplantation in patients with Parkinson disease (PD)?

Is gene therapy safe and effective in the treatment of Parkinson disease (PD)?

How is dementia managed in patients with Parkinson disease (PD)?

What is the prevalence of depression in patients with Parkinson disease (PD)?

How is depression treated in patients with Parkinson disease (PD)?

Can medications for Parkinson disease (PD) trigger psychosis?

How is psychosis treated in patients with Parkinson disease (PD)?

How is anxiety treated in patients with Parkinson disease (PD)?

How are impulse behaviors treated in patients with Parkinson disease (PD)?

How are sleep disturbances treated in patients with Parkinson disease (PD)?

How effective is exercise and physical therapy in patients with Parkinson disease (PD)?

What is the prevalence of speech problems in patients with Parkinson disease (PD)?

What is the role of speech therapy in the treatment of Parkinson disease (PD)?

What is the Lee Silverman Voice Treatment (LSVT) program for Parkinson disease (PD)?

How effective is the Lee Silverman Voice Treatment (LSVT) program in improving laryngeal symptoms in patients with Parkinson disease (PD)?

Are there effective alternative therapies to the Lee Silverman Voice Treatment (LSVT) program?

Are speech and language therapy effective in the treatment of Parkinson disease (PD)?

Why is dietary fiber recommended for patients with Parkinson disease (PD)?

What is the effect of dietary protein on levodopa in patients with Parkinson disease (PD)?

How is levodopa-induced nausea avoided in patients with Parkinson disease (PD)?

Are there dietary options that are beneficial in the management of Parkinson disease (PD)?

Do vitamin E and coenzyme Q10 have a neuroprotective effect in patients with Parkinson disease (PD)?

What consultations may be indicated for patients with Parkinson disease (PD)?

When is a neurosurgical consultation indicated in patients with Parkinson disease (PD)?

When is a psychiatric consultation indicated in patients with Parkinson disease (PD)?

When is consultation with a urologist indicated in patients with Parkinson disease (PD)?

What is the benefit of consultation with a physiatrist, physical therapist, or occupational therapist in patients with Parkinson disease (PD)?

What is the benefit of consultation with a nutritionist in patients with Parkinson disease (PD)?

What is the benefit of an otolaryngologist consultation for patients with Parkinson disease (PD)?

How are dysphagia, excessive sialorrhea, or nutrition issues managed in patients with Parkinson disease (PD)?

How often should patients with Parkinson disease (PD) be monitored?

What types of treatments may be available in the future for Parkinson disease (PD)?

Guidelines

What are the AAN treatment guidelines for nonmotor symptoms of Parkinson disease (PD)?

Medications

Which medications are used in the treatment of Parkinson disease (PD)?

Which medications in the drug class Dopamine Agonists are used in the treatment of Parkinson Disease?

Which medications in the drug class Anticholinergic are used in the treatment of Parkinson Disease?

Which medications in the drug class MAO-B inhibitors are used in the treatment of Parkinson Disease?

Which medications in the drug class Acetylcholinesterase Inhibitors, Central are used in the treatment of Parkinson Disease?

Which medications in the drug class NMDA Antagonists are used in the treatment of Parkinson Disease?

Which medications in the drug class COMT Inhibitors are used in the treatment of Parkinson Disease?

Which medications in the drug class Selective Serotonin Inverse Agonists (SSIA) are used in the treatment of Parkinson Disease?

Which medications in the drug class Adenosine Antagonists are used in the treatment of Parkinson Disease?