diagnostic criteria for Parkinson Disease

 Q: 62 years old male is recovering in ICU with pneumonia. A physical therapist is worried about patient having underlying Parkinson's Disease (PD) due to difficulty in mobilization. Which of the following is NOT considered as a diagnostic criterion for Parkinson's Disease? 

A) tremor

B) bradykinesia

C) rigidity

D) postural instability

Answer: D

The three classics and cardinal features of PD are 

• tremor 
• bradykinesia, and 
• rigidity 

 Postural instability is relatively a late presentation and is not considered a part of diagnostic criteria. Said that severity of postural instability has two clinical implications. It is minimally responsive to dopaminergic therapy and is an independent predictor of mortality for PD.  

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#geriatrics

References:

1. Gelb DJ, Oliver E, Gilman S. Diagnostic criteria for Parkinson disease. Arch Neurol 1999; 56:33. 

2. Forsaa EB, Larsen JP, Wentzel-Larsen T, Alves G. What predicts mortality in Parkinson disease?: a prospective population-based long-term study. Neurology 2010; 75:1270. 

3. Koller WC, Glatt S, Vetere-Overfield B, Hassanein R. Falls and Parkinson's disease. Clin Neuropharmacol 1989; 12:98.