Parkinson's disease: Clinical manifestations and treatment

This review describes and synthesizes the clinical manifestations, differential diagnosis, and treatment of Parkinson's disease (PD). PD is a common neurodegenerative disorder affecting approximately 0. 5 to 1% of the population over the age of 65. The cardinal features of PD include tremor, bradykinesia, rigidity and postural instability. There are also a number of secondary features that are important to recognize and treat, including cognitive dysfunction, depression, anxiety, autonomic dysfunction, and disturbances of sleep. Only approximately 75-80% of patients that present with parkinsonian features have idiopathic PD. Other disease entities that can present with parkinsonism are reviewed. It is important to recognize these disorders since treatment and prognosis for the parkinsonian syndromes are markedly different from idiopathic PD. In addition, current medical and surgical approaches for the treatment of PD are reviewed. The mainstay of treatment for PD remains levodopa, but there are a number of supplementary medications including anticholinergics and dopamine agonists, which are useful in the treatment of PD. Surgical approaches including thalamotomy, pallidotomy and deep brain stimulation are receiving increased attention as adjunctive therapy for treatment of PD.