CHART NOTE
This very pleasant 74-year-old woman has rather advanced parkinsonism present for many years. It is affecting her daily living to a great degree. She has difficulty dressing, has frequent falls occasionally related to freezing or to festination but also occurring without any apparent cause. She has marked hesitancy on changing direction and unsteadiness with fatigue. She has a minor problem with sialorrhea, eating, and swallowing. She is able to maintain her personal hygiene without any difficulty. She has had some symptoms of depression along with her Parkinson disease.
On neurologic exam, she did have mild-to-moderate impairment in cognition and short-time memory, although she is oriented x3. She has mild tremor, worse in the left arm than the right. She has rigidity in the upper left extremity. She has marked poverty of movement with long delays in initiating movement and frequent freezing. She has a moderately flexed posture and cannot straighten to command. She has postural instability. Her speech is mildly dysarthric. She has paucity of spontaneous facial expression. Her gait is characterized by shuffling strides with festination in propulsion. She does not need assistance with gait. She can arise from a chair with difficulty only after multiple attempts. She has micrographia. Deep tendon reflexes are symmetrical, and toes are downgoing. Cranial nerves are unremarkable.
She is on Sinemet 25/100 t.i.d. for the last 6 years or so. She will be going on vacation soon, and I would not attempt to add a second antiparkinsonian medication. However, I have asked her to increase her Sinemet dose to q.i.d. We will see how she does with Sinemet and plan to add bromocriptine 1 mg per day when she returns.
FOOTNOTE
Line 33. The dictator says stroke (/) to designate a slash mark (virgule or diagonal).
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