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Parkinson Exam

Introduction

Greetings
Hand wash
Verify the patient's identity using at least two or three details
Explanation
Consent

Inspection

Overall wellness

Assess if patient appears well or unwell

Note on limb weakness / tremor or extra movements
Note any walking aids

While standing up

Gait (Assess by asking patient to walk in straight line, turn and walk back again and stop)
If patient uses walking aid → ask if it is safe to walk with or without aids
Assess for reduced arm swing
Shuffling gait
Destination
See if more steps taken on turning
Imbalance
Drift
Assess for festination
Assess retropulsion

Pull patient backwards from the shoulders. Assess for inability to maintain balance. Stand behind patient to catch them if they lose balance.

Timed get up and go

Face

Look for facial expression or mask like facies
Head titubation
Look for drooling or excess salivation

May be due to bradykinesia

Assess for glabellar tap

Positive when ongoing blink response to tapping

Assess eye movements

Loss of vertical gaze, predominantly upwards suggestive of Idiopathic Parkinson's. Loss of vertical and lateral gaze suggests PSP (Progressive Supranuclear Palsy).

Upper limb

Assess for tremor (Pill rolling tremor / Resting tremor / Intention tremor)

Check if tremor increases with distraction or decreases with intention

Ask to do nose to finger test for intention tremor
Test for fine motor (Tap on table like piano)

Assesses bradykinesia

Assess for tone in upper limb

Check for cogwheeling, lead pipe rigidity

Speech

Is the patient's speech monotonous and quiet? Any signs of palilalia (repeating word endings)?
Assess for micrographia

Ask patient to write a sentence and assess for small handwriting

Parkinson's Plus symptoms

Check for autonomic dysfunction (lying and standing BP)

Ask about

Falls
Bowel movement
Say you would do an MMSE for dementia
Wash hands

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