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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Identify motor and nonmotor symptoms of Parkinson's disease (PD) as well as symptoms that indicate disease progression

  • Explain the desired therapeutic goals for patients with PD

  • Recommend lifestyle modifications and pharmacotherapy interventions for treating motor symptoms of patients with PD

  • Recommend drug and nondrug interventions for treating the nonmotor symptoms of patients with PD

  • Develop a monitoring plan to assess the effectiveness and adverse effects of nonpharmacologic therapy and pharmacotherapy for PD

  • Educate patients about the disease state, appropriate lifestyle modifications, and drug therapy required for effective treatment

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PATIENT PRESENTATION

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Chief Complaint

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"My primary care physician says I might have Parkinson's disease."

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History of Present Illness

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Oliver Covey is a 62-year-old, right-handed man who is referred to a neurologist by his primary care physician. He was visiting his primary care physician for a routine checkup appointment. At that time, his primary care physician noted that the patient had a mild, right-hand tremor and walked with reduced arm swing. His primary care physician felt that these signs and symptoms were compatible with possible Parkinson's disease (PD) and referred him to a neurologist for further assessment. At the neurologist visit, the patient is accompanied by his wife. He states that he is in good spirits. He admits noticing the tremor in his right hand about 1 year ago, but did not think much of it. His wife has also noticed the tremor. The patient states no other problems. However, his wife reports he walks a bit slower and that his "tennis game has gotten worse." She states that he used to be very agile on the tennis court but during the past year has "slowed considerably and often misses shots." The patient admits this is true. When asked about his employment and work capabilities, he states the movement problems do not interfere. The neurologist asks, "If there is one thing we can make better about your movement, what would it be?" The patient replies, "I want to be able to swing the tennis racket like I used to a year ago." He is willing to start drug therapy to help improve his movement.

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Past Medical History

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BPH × 1 y

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GERD × 1 y

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Hyperlipidemia × 5 y

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Nephrolithiasis in the past

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Tonsillectomy

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Family History

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He is an only child. His father died of MI. Mother died of some other type of cardiac problem. No family history of neurologic conditions.

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Social History

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He was born in Arizona and lives in Los Angeles. He has a college education. He is married and lives with his wife of 32 years, and has two children aged 30 and 25. He works as an ...

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