Changes

*H&P: Neurodegenerative progressive disease with motor symptoms (pill-rolling tremor, cogwheel rigidity, masked facies, stooped posture, shuffling gait, trouble initiating movements, soft speech) preceding neuropsychiatric symptoms (dementia, depression, psychosis). Caused by destruction of dopaminergic neurons in the substantia nigra.  

*H&P: Neurodegenerative progressive disease with motor symptoms (pill-rolling tremor, cogwheel rigidity, masked facies, stooped posture, shuffling gait, trouble initiating movements, soft speech) preceding neuropsychiatric symptoms (dementia, depression, psychosis). Caused by destruction of dopaminergic neurons in the substantia nigra.  

*Dx: 2/4 TRAP symptoms (Tremor, Rigidity, Akinesia/Bradykinesia, Postural instability) one of which must be bradykinesia. Rule out other causes of Parkinsonism with MRI (e.g. drugs, vascular dementia, Lewy body dementia, multi system atrophy). Responds to carbidopa-levodopa.

*Dx: 2/4 TRAP symptoms (Tremor, Rigidity, Akinesia/Bradykinesia, Postural instability) one of which must be bradykinesia. Rule out other causes of Parkinsonism with MRI (e.g. drugs, vascular dementia, Lewy body dementia, multi system atrophy). Responds to carbidopa-levodopa.

*Tx: 1st line Carbidopa-Levodopa. '''DA agonists''' ('''Pramipexole''', Ropinarole, '''Bromocriptine'''. '''Anti MAO (selegiline), anti COMT (etacapone), and anticholinergics (benztropine)'''. Deep brain stimulator or pallidectomy.

*Tx: 1st line Carbidopa-Levodopa. '''DA agonists''' ('''Pramipexole''', '''Bromocriptine''', Ropinarole). '''Anti MAO (selegiline), anti COMT (etacapone), and anticholinergics (benztropine)'''. Deep brain stimulator or pallidectomy.

==Huntington Disease==

==Huntington Disease==