Patient Encounter Part 1

MW, a 65-year-old man with a 2-year history of mild depression, comes for an initial visit to evaluate his symptoms of tremor and slowness. The tremor started in his right hand about 6 months ago, and he does not remember how long he has been slower at completing his tasks. His wife reports that for the last 4 months he has been slower and that he kicks her while they are sleeping.

Identify this patient's motor and nonmotor symptoms of PD.

What additional information would you collect before creating this patient's treatment plan?

Extrapyramidal Motor System
FIGURE 32-1. Anatomy of the extrapyramidal system. The extrapyramidal motor system controls muscle movement through a system of pathways and nerve tracts that connect the cerebral cortex,

basal ganglia, thalamus, cerebellum, reticular formation, and spinal neurons. Patients with PD have a loss of dopamine neurons in the substantia nigra in the brainstem that leads to depletion of dopamine in the corpus striatum. The corpus striatum is made up of the caudate nucleus and the lentiform nuclei that are made up of the putamen and the globus pallidus.

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