Parkinson's new

Impression: Parkinson's Disease, newly diagnosed. Past Medical History: 1. Hypertension 2. Hypercholesterolemia Current Medications: 1. Amlodipine 5mg daily 2. Atorvastatin 20mg nocte Management Plan: 1. Commence Levodopa/Carbidopa 100/25mg three times daily. 2. Review in 3 months. Thank you for referring this 72-year-old right-handed male who attended the neurology clinic. He is a retired accountant who was referred with a resting tremor in his right hand. He denies any history of anosmia, REM sleep behaviour disorder, constipation, memory problems, visual hallucinations, mood swings, bladder control issues, or postural lightheadedness. His wife reports that he has been experiencing a tremor in his right hand for the past six months, which is worse at rest and improves with activity. She also notes that he has become increasingly slow in his movements and has a stooped posture. Specifically screened for anosmia, REM sleep behaviour disorder (dreams enactment such as kicking, shouting, screaming or laughing out of dreams), constipation, memory, visual hallucinations, mood, bladder control and postural lightheadedness. The patient denies any of these symptoms. He has not tried any previous treatments for his tremor. Past medical issues include hypertension and hypercholesterolemia. There is no significant family medical history. There is no family history of similar conditions or relevant neurological disorders. He lives with his wife, does not drink alcohol, does not smoke, and does not use any illicit drugs. He is still driving, but this will be reviewed at the next appointment. Results of previous investigations: MRI brain showed no significant abnormalities. The neurological examination: Examination revealed a resting tremor in the right hand, bradykinesia, rigidity in the right arm, and a stooped posture. Gait was slightly shuffling. Cognitive examination was normal. Summary: Based on the history, examination findings, and investigations, the patient has been diagnosed with Parkinson's Disease. The patient was educated about the condition, emphasising the importance of physical activity and exercise. The patient was advised to start Levodopa/Carbidopa and to return for a review in three months.