Parkinson's Disease for USMLE Step 3 / COMLEX-USA Level 3

• Motor Symptoms:
• Bradykinesia: Slowness in initiating and executing movements.
• Rigidity: Uniform stiffness throughout the limbs and trunk.
• Resting Tremor: Typically a "pill-rolling" tremor at rest.
• Postural Instability: Increased risk of falls, typically observed in later stages.
• Non-Motor Symptoms:
• Neuropsychiatric: Depression, anxiety, and cognitive decline.
• Autonomic Dysfunction: Constipation, urinary urgency, orthostatic hypotension.
• Sleep Disturbances: Particularly REM sleep behavior disorder.

• Clinical Evaluation: Diagnosis is primarily clinical, based on motor symptoms and response to dopaminergic therapy.
• Imaging:
• DaTscan: Helps confirm the diagnosis by showing reduced dopamine transporter in the striatum, not used routinely.
• Neurological Assessment: Comprehensive assessment to rule out other causes of parkinsonism.

• Pharmacological Treatment:
• Levodopa/Carbidopa: Most effective treatment, adjusted based on symptom control and side effects.
• Dopamine Agonists: Such as pramipexole and ropinirole, useful especially in younger patients.
• MAO-B Inhibitors: For mild symptoms or as adjunct therapy.
• COMT Inhibitors: Used to extend the effect of Levodopa.
• Non-Pharmacological:
• Physical and Occupational Therapy: Focus on improving mobility and daily function.
• Speech Therapy: Addressing speech and swallowing difficulties.

• Motor Fluctuations: Such as "wearing off" effects or "on-off" phenomena.
• Dyskinesias: Involuntary movements arising from long-term Levodopa use.
• Cognitive Decline and Psychiatric Issues: Management of dementia and hallucinations, often requiring psychiatric consultation.

• Progressive Nature of Disease: Monitoring for progression and complications.
• Adjustments in Treatment: Based on disease stage, patient age, and comorbidities.

1. Management of Advanced PD: Emphasis on the integration of pharmacological and non-pharmacological treatments to address both motor and non-motor symptoms. 2. Decision-Making in Drug Selection: Choosing appropriate therapy based on patient-specific factors such as age, symptom severity, and side effect profiles. 3. Handling Complications: Strategies for managing common and complex complications such as dyskinesias, psychiatric symptoms, and cognitive decline. 4. Interdisciplinary Care: Coordination with various healthcare professionals to provide comprehensive care, including palliative care considerations.