L.C. is a 78-year-old white man with a 4-year history of Parkinson’s disease (PD). He is a retired engineer, is married, and lives with his wife in a small farming community. He has 4 adult children who live close by. He is taking carbidopa-levodopa, pergolide, and amantadine. L.C. reports that overall he is doing “about the same” as he was at his last clinic visit 6 months ago. He reports that his tremor is about the same, his gait is perhaps a little more unsteady, and his fatigue is slightly more noticeable. L.C. is also concerned about increased drooling. The patient and his wife report that he is taking carbidopa-levodopa 25/100 mg (Sinemet), 1 tablet an hour before breakfast and 1 tablet 2 hours after lunch, and carbidopa-levodopa 50/200 mg (Sinemet CR), 1 tablet at bedtime. On the previous visit they were encouraged to try taking the carbidopa-levodopa (Sinemet) more times throughout the day, but they report that he became very somnolent with that dosing regimen. He also reports that his dyskinetic movements appear to be worse just after taking his carbidopa-levodopa.
1. What is parkinsonism?
It is a condition that causes tremors, slow movement, impaired speech or muscle stiffness. 2. What is PD?
A progressive neurodegenerative disease that shows low dopamine levels. There is 4 cardinal symptoms, tremor, rigidity, bradykinesia, or akinesia. 3. What are the clinical manifestations of PD? Place a star next to the symptoms L.C. has mentioned. The clinical manifestations are mask like, blank expression, stooped posture, pill rolling tremors, shuffling, propulsive gait*, muscle rigidity, tremors*, slow jerky movements, depression, fatigue*, mental deterioration, bradykinesia, loss of normal arm swing while walking, decreased blinking of eye lids, drooling*, loss of ability to swallow, blank expression, difficulty initiating movement. 4. L.C.’s wife asks you, “How do the doctors know L.C. has...