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By Hailey Nealen, Naomi Belcher, and Alexis Beyke
John, 55 years old, comes in to your office with his wife, Rita. She is
concerned because she has seen some changes in her husband. She
reports that at some points he seems to be moving in slow motion.
Getting dressed and ready to leave the house in the morning seems to
take longer every day. She has also noticed that he often loses his balance
and when he thinks she is not looking, he often keeps a hand on the wall
for support. John keeps relatively quiet and when asked, claims nothing is
wrong, but as he passes you his paperwork, you notice that his hand is
shaking. You look down at the paper and notice that his handwriting is so
tiny that it’s almost illegible.
He seems to move in slow motion.
He takes longer to do simple tasks.
He loses his balance and often needs support.
His hands shake/he has tremors.
He is relatively quiet.
 1:38-4:04
First we identified his symptoms and researched what diseases the
diseases were associated with the symptoms.
Then we researched the diseases that we found in order to determine
the disease that most related to the symptoms.
After we determined the most relevant disease we went into more
exclusive research in that disease.
We believe that John has Parkinson's Disease.
Other possible diagnosis include Dystonia, and Progressive
Supranuclear Palsy.
Dystonia is involuntary muscle contractions that cause repetitive or
twisting movements.
Symptoms associated with Dystonia that led us to believe that it was a
 Involuntary muscle contractions that can affect handwriting.
 Becomes more noticeable over time- he took more and more time to get
ready in the mornings.
 Affects muscles in vocal cords, causing whispering or tight voice - He’s been
quiet lately.
PSP is a degenerative disease involving the gradual deterioration and
death of specific volumes of the brain
Symptoms associated with PSP that led us to believe that he could
possibly have Progressive Supranuclear Palsy:
 Loss of balance while walking- He held a hand on the wall to balance himself.
 Can even in rare cases cause tremors- He was shaking as he handed the
doctor his paperwork.
Idiopathic Parkinson’s
 Most common type
 Main symptoms are: tremor, rigidity, and slowness of movement
Vascular Parkinson’s
 One of the atypical forms of Parkinsonism
 Affects people with restricted blood supply to the brain
 Symptoms include: difficulty speaking, making facial expressions, or swallowing
Drug-induced Parkinsonism
 Neuroleptic drugs (used to treat schizophrenia and other psychotic disorders) block dopamine.
 Dopamine is a chemical in the brain that allows messages to be sent to the parts of the brain that coordinate movement.
 Symptoms appear when dopamine level falls
Inherited Parkinson’s
 5% of people with Parkinson’s may have genetic cause
 Still research about it
Juvenile Parkinson’s
 Used when condition affects people under the age of 20.
Inconsistencies may have lead to incorrect diagnosis causing the
patient to never truly know what is wrong.
Inconsistencies include:
Many diseases contain the same symptoms leading to unsure diagnosis.
 Some symptoms such as being quiet or tiny, illegible handwriting could be
caused from personality traits or style, not medical reasons.
 Incorrect results from testing or reports could lead to incorrect conclusions.
There are no specific tests that are available to determine whether or
not you have Parkinson’s Disease, but there are tests to rule out other
diseases or determine Parkinson's as a possibility.
Doctors may perform observational test such as examining tremor of the arms,
ability to regain balance, gait, ability to move and stiffness in your limbs and
Tests and scans on the brain might also be preformed in order to eliminate
diseases or find the source of a problem. Scans such as MRI, an ultrasound of
the brain, SPECT, CAT, and PET scans.
Parkinson’s disease is not a fatal illness. However, it’s a degenerative
disorder that usually progresses until it leaves its patients completely
debilitated. The condition usually worsens over an average of 15 years.
The rate of progression and its course varies among patients. The
course is relatively began in some patients with little disability after
twenty years and may be more aggressive among others who may be
severely disabled after ten years. Those with an early onset Parkinson’s
disease have shorter life spans than those with later-onset disease.
Untreated, Parkinson’s disease worsens over years. Parkinson's may
lead to a deterioration of all brain functions and an early death. Life
expectancy however is normal to near normal in most treated patients
of Parkinson’s disease.
Most people respond to medications. However, the extent of
responsiveness and the duration of how long the efficacy of the drug lasts
varies from person to person. The side effects of medications are another
deterrent in their use.
Movement disorder symptoms differ from person to person. For some they
are more bothersome than others depending on what a person normally
does during the day. In some the mild symptoms may last for many years
while in others they may develop more quickly. Non-motor symptoms may
also vary from person to person. They affect most people with Parkinson's
at all stages of disease. Some people with Parkinson's find that symptoms
such as depression or fatigue may be more cumbersome to deal with that
the movement disorders themselves.
In Parkinson’s Disease the area of error most occurs in the midbrain, more
specifically in the Substantia nigra, cerebellum, and the motor cortex.
One error in Parkinson’s Disease is that Lewy Bodies (unusual clumps of
alpha-synuclein, a protein in the brain) form in the neurons, damaging the
flow of impulse within the cell causing information to be fractured or move
Lack of dopamine within the neurons in another error. When neurons
become impaired or die, as they do in Parkinson’s Disease, they don’t
produce enough dopamine causing movement impulse to be impaired or
not occur throughout the body.
An over production of acetylcholine within the motor cortex causes an
increased number of muscle impulses, causing people with Parkinson’s
Disease to have tremors.
Movement Disorder Specialist may be used when dealing with
Parkinson’s Disease. They are a special type of neurologist who
diagnose and treat people with movement disorders.
Occupational Therapists may also be used in order to help cope with
the disease. They help people mentally recuperate from a disease,
and create programs and treatments in order to help people carry out
ordinary daily tasks.
Physical Therapists treat people who have medical conditions, such as
Parkinson’s Disease, that limit their ability to move and function in
their daily lives. They develop plans and treatments that may help to
reduce pain and restore function of movement. They also help
prevent the loss of mobility.
Parkinson’s Disease cannot be cured, but its symptoms can be
controlled and suppressed.
Amantadine is an antiviral prescription drug that is used to subdue the
uncontrollable muscle movements caused by Parkinson’s Disease. It produces
chemicals in the brain which help to combat Parkinson’s Disease.
Physical Exercise is also a great way to deal with the symptoms of Parkinson’s, it
reduces stiffness, improves mobility, posture, balance and gait, and can increase
oxygen delivery to neurotransmitters.
Benztropine is a prescription drug that controls tremors and stiffness of muscles
by decreasing the effects of acetylcholine which is a chemical in the brain that
activates muscle movement of motor neurons.
Dr. Ananya Mandal, MD. (2013). Parkinson's Disease Prognosis. News Medical. [Accessed 8 October 2015]. Retrieved from (2015). Benztropine. [Accessed 8 October 2015]. Retrieved from (2015). Amantadine. [Accessed 8 October 2015]. Retrieved from
Mayo Clinic. (2012). Dystonia. [Accessed 8 October 2015]. Retrieved from
Mayo Clinic. (2015). Parkinson's disease. [Accessed 8 October 2015]. Retrieved from
Mount Sinai Beth Israel Department of Neurology. (nd). Parkinsons Disease and Other Movement Disorders. [Accessed 8 October
2015]. Retrieved from
National Institute of Neurological Disorders and Stroke. (2015). Progressive Supranuclear Palsy Fact Sheet. [Accessed 8 October
2015]. Retrieved from
NIH Senior Health. (nd). What Causes Parkinson's Disease?. [Accessed 8 October 2015]. Retrieved from
Parkinson’s UK. (2014). Types of Parkinson’s an Parkinsonism. [Accessed 8 October 2015]. Retrieved from
Parkinson's Disease Clinic and Research Center. (2012). Exercise and Physical Therapy. [Accessed 8 October 2015]. Retrieved from
Parkinson’s Disease Foundation. (nd). Diagnosis. [Accessed 8 October 2015]. Retrieved from
Prospects. (2014). Occupational Therapist. [Accessed 8 October 2015]. Retrieved from