Examination ComponentFindings and what they may mean
Mental status Cognitive impairment on theMMSEorMoCAmay
indicatecognitive impairment and/or dementia If visual
hallucinations anddementiaare present before or within a year on
parkinsonism onset, then consider the diagnosis of dementia with
Lewy Bodies (DLB) Depression, apathy and anxiety are common but not
exclusive of PD
Cranial nerves Impaired vertical eye movements would make one
suspicious of progressive supranuclear palsy (PSP) Check for
hyposmia-it is usually an early marker of PD. You can use the
UPSITitest Masked face is typical in PD PD patients may have a soft
voice and /or mumbled or fast speech
MotorExamination Asymmetric restingtremorwithbradykinesiaon one
side is very typical of PD PDtremorsmay occur in the tongue, jaw,
lower lip, hand, or in the leg/foot PDtremorworsens with
distracting the patient with mental tasks, etc Cogwheelrigidityis
typical of PD Many patients have drooling due to reduced
spontaneous swallowing of saliva Diminished gesturing is common in
PD Micrographia is typical of PD
Sensory examination Impaired position sense in the toes may
indicate that the patient has a sensory ataxia on top of PD gait
problems Sensory examination is usually unremarkable
Coordination examination Conduct a dexterity test. Ask patient
to finger tap. Finger taps should have not only amaintained speed
over 10-15 seconds but a maintained amplitude as well; slowing of
speed, decrement of amplitude, and pauses/arrests in finger and
foot taps are consistent withbradykinesia Ataxia would make one
concerned about the possibility of multiple system atrophy
(MSA)
Deep tendon reflexes Asymmetry of reflexes and up going plantar
responses (Babinski sign) may indicate prior strokes/brain infarcts
and vascular parkinsonism; or an up going toe would be suggestive
of MSA
Gait and balance Gait dysfunctionis frequently multifactorial,
and not just related to parkinsonism Freezing of gaitis related to
PD A PD patient may have difficulties in rising from the chair A PD
patient may have difficulties in taking the first step A PD patient
may have limitations in turning Reduced arm swing is common in PD
Postural instabilityis common. It can be measured with the Pull
Testi. PD patients may have problems maintaining their balance
Timed Up and Go (TUG) testcan be helpful for evaluation
Other Check for skin changes-melanoma
