History

Credit: Paul J. Tuite, M.D.

The first part of the examination involves taking a specific patient history, and inquiring into factors such as:

• Genetic background: A careful family history may reveal a propensity to develop a neurodegenerative disease such as early-onset Parkinson's disease, ALS (amyotrophic lateral sclerosis, also known as Lou Gehrig's disease), dementia, parkinsonism, tremor disorders, etc.


• Psychiatric history: A psychiatric history should review for disorders that include depression, anxiety, bipolar disorders, schizophrenia, and addiction disorders. These conditions are usually unrelated to Parkinson's disease, but they may represent additional factors that affect the course of the disease. Medication treatment for psychiatric symptoms may be a potential reversible cause of parkinsonism. (See below.)


• Previous head trauma: Several prior significant head traumas resulting in loss of consciousness have been associated with an increased risk of Parkinson's disease.


• Primary symptoms


• Medication exposure: Medications such as metoclopramide (Reglan®), amoxapine, and antipsychotics can induce a medication-induced parkinsonism, due to their effects on dopamine signaling in the brain. (These conditions are potentially reversible by discontinuing the "offending" medications.)


• Exposure to environmental toxins: Exposure to carbon monoxide, manganese, the fungicide maneb, the pesticide rotenone, and others may increase the risk of developing parkinsonism, or possibly, Parkinson's disease.