Ver el código de «Parkinson's disease»

==Background==
*Extrapyramidal movement disorder associated with reduced dopaminergic receptors in substantia nigra
*Most common presentations to the ED<ref>Guneysel O et al. Parkinson’s disease and the frequent reasons for emergency admission. Neuropsychiatr Dis Treat. 2008 Aug; 4(4): 711–714.</ref>:
**Infectious ~32%
**Trauma ~28%
**Cardiovascular ~15%
**Cerebrovascular ~12%
**GI ~7%
**Electrolyte abnormalities 6%

==Clinical Features==
===TRAP mnemonic===
*[[tremor|'''T'''remor]] (resting)
**Initially is unilateral tremor of upper extremity, especially finger and thumb ("pill rolling")
**Dissipates when intentional movement is performed
*'''R'''igidity (cogwheel)
**Elicited by causing passive movement of limb through full range of motion
*'''A'''kinesia
**Slowness of voluntary movement
*'''P'''osture/equilibrium impairment
**Impaired ability to turn or change direction while walking

==Differential Diagnosis==
{{Dementia DDX}}
{{Movement disorder DDX}}

==Evaluation==
*Consider [[mini mental status exam]]

==Management==
''Initiation of or modifications in medications should be made in conjunction with neurologist''
*Dopamine agonists
**[[Levodopa]] and [[carbidopa]] (peripheral decarboxylase inhibitor) = gold standard
**[[Pramipexole]] (Mirapex)
**Ropinirole (Requip)
*[[Anticholinergics]]
**[[Benztropine]] - caution in acute psychosis
*Monoamine oxidase inhibitor - blocks DA reuptake 
**Selegiline (Eldepryl) 
**Rasagiline (Azilect)
*Agents for [[psychosis|psychotic symptoms]], [[hallucinations]]
**Pimavanserin (Nuplazaid) - serotonin inverse agonist (not anti-dopamine), FDA approved in 2016<ref>FDA approves first drug to treat hallucinations and delusions associated with Parkinson’s disease. April 29, 2016. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm498442.htm.</ref>
**Avoid antidopaminergic drugs if possible (expect worsening motor symptoms), but commonly used agents:
***[[Olanzapine]]
***[[Quetiapine]]
**Others:
***Rivastigmine
***[[Citalopram]] in depressed patients

==Disposition==
*Usually treated as outpatient
*Admit according to presentation

==See Also==
*[[Dementia]]

==References==
<references/> 
[[Category:Neurology]]