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69 yo Male - Movement & Cognitive Changes (Central Case) - Coggle…
69 yo Male - Movement & Cognitive Changes (Central Case)
Key Symptoms & PE Findings
Motor/Gait:
Shuffling Gait, Slow Movement, Difficulty Lifting Feet
Trace Resting Tremor (Left Hand)
Non-Motor/Cognitive:
Soft Voice (Hypophonia), Flat Affect
Decreased Smell/Taste (Hyposmia)
Forgetfulness, Agitation, Constipation
Most Likely Diagnosis (MLD): Parkinson's Disease (PD), Second Dx- Alzhiemer's disease (AD)
Pathophysiology Comparison (PD vs AD)
Symptom Similarities (Overlaps):
Causes progressive Cognitive Decline (Forgetfulness/Agitation)
Gait/Motor Issues: Both can cause slowness and falls
Pathophysiology Differences (Contrasts):
PD Location/Protein:
Site of Damage: Substantia Nigra (Dopamine Neurons)
Protein: alpha-Synuclein aggregates into intracellular
Lewy Bodies
Mechanism: Progressive loss of Dopamine (leading to impaired motor function)
Alzheimer's Disease Location/Protein:
Site of Damage: Hippocampus and Cerebral Cortex
Protein:
Amyloid Plaques
and
Tau Tangles
(Intracellular)
Mechanism: Leads to memory/cognitive failure (Acetylcholine deficit)
DDX Changes Based on Age (Part 2)
86 yo Patient: (Vascular & Severe Degeneration)
Vascular Parkinsonism (VP): Much more likely due to vascular risk factors (HTN, CVA history)
Normal Pressure Hydrocephalus (NPH): Incidence rises; gait & cognitive issues are key
Malignancy / Subdural Hematoma: Must screen for space-occupying lesions in acute decline
23 yo Patient: (Genetic, Metabolic, & Inflammatory)
Wilson's Disease: High priority rule-out (ataxia, tremor, psychiatric changes)
Multiple Sclerosis (MS): Inflammatory cause of gait ataxia, fatigue, cognitive deficits
Juvenile Parkinsonism: Extremely rare, genetically-linked onset
REFERENCES:
•McCance, K. L., & Huether, S. E. (2023). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Elsevier.
•Pahwa, R., & Jialal, I. (2024). Parkinson Disease. StatPearls Publishing.