Parkinson disease is a slowly progressive brain disorder in which dopamine-producing nerve cells are lost, causing slowness, stiffness and a resting tremor. Non-motor problems such as constipation, low mood, sleep trouble and later memory loss are common.
Key symptoms
- Resting tremor, often a pill-rolling hand on one side
- Slow movements and small handwriting
- Stiffness and a soft, quiet voice
- Shuffling gait, freezing and falls
- Constipation, loss of smell, depression and acting out dreams
What you find on exam
- Bradykinesia on finger tapping, worse with repetition
- Cogwheel rigidity at the wrist
- Masked face, reduced blinking and arm swing
- Gait, turning and the pull test for balance
- Orthostatic blood pressure
Tests
- Diagnosis is clinical, based on history and exam
- A clear response to levodopa supports the diagnosis
- MRI brain or DaT scan only in unclear cases
- Review drugs that cause parkinsonism, such as haloperidol and metoclopramide
Treatment basics
- Carbidopa-levodopa, given on time every time
- Dopamine agonists such as pramipexole or MAO-B inhibitors such as rasagiline
- Physical, occupational and speech therapy; regular exercise
- Fall prevention and swallow assessment
- Deep brain stimulation for selected patients
Red flags
- Missed levodopa doses with fever and rigidity
- Choking, coughing with meals or pneumonia
- Hallucinations, confusion or repeated falls
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NCSBN 2026 NCLEX-RN Test Plan. Written by Making Synapses. Making Synapses is not affiliated with these organizations.