Parkinson’s Disease and Other Movement Disorders

Movement disorders, including Parkinson’s disease, are common in older adults. Despite their prevalence, misdiagnosis is common, and disability due to these conditions can be high. Making an accurate diagnosis, conducting thorough examination and evaluation, and taking a careful patient-centered treatment approach can have a major impact on quality of life and functional status. Parkinson’s disease is a prevalent condition, often with onset in the seventh decade of life, associated with rest tremor, slowness of movement (bradykinesia), and stiffness (rigidity), as well as nonmotor symptoms including depression, anxiety, constipation, orthostasis, insomnia, and REM behavior disorder. Treatment with dopaminergic agents can dramatically improve mobility and quality of life. Essential tremor is a very common, often familial tremor disorder that most commonly affects action, for example, handwriting, using utensils, or holding a phone. While disabling, treatment with assistive devices and medications can be very effective. Medication can also induce movement disorders: Drug-induced tremor and drug-induced parkinsonism are common, reversible, treatable conditions with higher incidence in older patients. Dystonia, chorea, ataxia, restless leg syndrome, and several other conditions are less common but also important to recognize to ensure appropriate evaluation and treatment.