Case 034: Parkinson Disease

PATIENT PRESENTATION

Chief Complaint

“The medication seems to wear off and my legs have been swollen”

History of Present Illness

KC is a 77-year-old left-hand male patient who presents for his 3 month follow-up visit in the Movement Disorders clinic for management of his Parkinson Disease.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. Which signs and symptoms are associated with PD and what is your assessment of the severity of his motor signs and symptoms as rated by the neurologist?

   Hint: See Clinical Presentation and Diagnosis in PPP

2. Based on the subjective and objective information, what do you think are this patient’s most significant medical problems?

   Hint: See Treatment in PPP

3. What current medications may be contributing to this patient’s problems and how so?

   Hint: See Treatment in PPP

4. What pharmacotherapy recommendations can you provide to address this patient's current problems?

   Hint: See Table 34-2 and Table 34-3 in PPP

5. What non-pharmacological recommendations can you provide for this patient?

   Hint: See Table 34-1 and Table 34-3 in PPP

FOLLOW-UP

Given this new information, what is your assessment and what are the treatment goals and treatment options for this patient?

Hint: See Clinical Presentation and Diagnosis and Table 34-3 in PPP

CASE SUMMARY

Global Perspective

Parkinson Disease affects approximately 6.1 million individuals worldwide. The number of individuals with PD has more than doubled since 1990. One contributor to the increasing number of individuals living with PD is longer life expectancy. Globally, the incidence of PD does not seem to vary between countries, but access to treatments may vary as can exposure to identified risk and protective factors. Diagnostic criteria and clinical guidelines for the treatment of Parkinson Disease are intended for international use given similarity in disease presentation. The most effective therapy for PD is levodopa, which nearly every patient with PD will ultimately require as the disease progresses. Similarly, motor complications occur in most patients with PD after treatment for at least 10 years. There are a multitude of pharmacologic and non-pharmacologic recommendations that can be implemented or adjusted to help with quality of life.

Key References