tailieunhanh - Ebook Fundamentals of geriatric medicine: Part 2

Part 2 book “Fundamentals of geriatric medicine” has contents: Dizziness and syncope, instability and falls, cardiovascular and peripheral arterial diseases, diabetes mellitus, thyroid disorders, anemia in the elderly, erectile dysfunction, urinary incontinence, pressure ulcers, and other contents. | 16 Parkinson’s Disease and Related Disorders Daniel E. Wollman Learning Objectives Upon completion of the chapter, the student will be able to: 1. Differentiate parkinsonism, Parkinson’s disease, and other movement disorders. 2. Understand the diagnostic evaluation for movement disorders. 3. Appreciate the management considerations in parkinsonism and Parkinson’s disease. Case (Part 1) . is a 68-year-old man whom you have seen in your primary care practice for many years. He has been extremely healthy, and is currently on no medications. You see him once a year for his annual screening and influenza vaccination. At today’s visit, he offers several new complaints. His friends are frequently asking him if things are okay and tell him he has a “sad look” on his face. In addition, many people have begun asking him to speak more loudly. He always prided himself on his fancy penmanship and notices now that his handwriting has become quite small. General Considerations Parkinson’s disease (PD) is a common disorder among the elderly population. Its incidence increases with age from less than 10 per 100,000 at age 50 to more than 200 per 100,000 at age 80 (1). After the 9th decade, its Material in this chapter is based on the following chapter in Cassel CK, Leipzig RM, Cohen HJ, Larson EB, Meier DE, eds. Geriatric Medicine: An EvidenceBased Approach, 4th ed. New York: Springer, 2003: Masdeu JC, Rodriguez-Oroz MC. Abnormalities of Posture and Movement, pp. 1139–1162. Selections edited by Daniel E. Wollman. 289 290 Daniel E. Wollman Table . Characteristics of movement disorders Type Resting tremor Postural tremor Action/kinetic tremor Chorea Dystonia Myoclonus Distinguishing features Present when body part at rest Present with fi xed posture or position (., holding a teacup) Present during limb movement Arrhythmic, rapid, often jerky, purposeless movements Involuntary sustained muscle contraction that produces twisting movements and abnormal postures in axial