QLexNursing

Muscle movements (resting tremors, generalized stiffness) → Parkinson disease

🟦 Parkinson disease classically causes resting tremor because of dopamine deficiency in the basal ganglia, especially the substantia nigra.

🟦 The tremor often begins unilaterally (like the right arm on Day 1) and progresses over time to become bilateral, matching the 6-month follow-up.

🟦 Parkinson also causes rigidity and increased muscle tone, which is why the client later has generalized stiffness in addition to tremors.

🟦 These motor changes are typically chronic and progressive, not sudden, which helps separate Parkinson from an acute stroke presentation.

🟦 Multiple sclerosis can cause weakness or spasticity, but resting tremor with progressive rigidity is far more consistent with Parkinson’s disease.

Ambulation pattern (slow, rigid gait) → Parkinson disease

🟦 A hallmark of Parkinson disease is bradykinesia, which leads to a slow gait and difficulty initiating movement.

🟦 The description of the gait being slow and rigid aligns with muscle rigidity and reduced automatic movements seen in Parkinson.

🟦 Parkinson gait often progresses toward a shuffling pattern with decreased arm swing, reflecting impaired motor control from basal ganglia dysfunction.

🟦 This is typically a gradual decline, which matches the timeline (worsening over 6 months).

🟦 Stroke-related gait changes are usually more sudden and often show unilateral weakness, while MS gait changes often fluctuate with relapses rather than steadily progressing this way.

Speech (slow → slow and slurred) → Parkinson disease (also can be seen in stroke)

🟦 In Parkinson disease, speech is often slow, soft, and monotonous due to bradykinesia affecting facial, tongue, and laryngeal muscles.

🟦 Over time, reduced muscle coordination can lead to dysarthria, which explains the progression to slow and slurred speech at 6 months.

🟦 Parkinson speech changes tend to be progressive, matching the shift from slow speech to slow/slurred speech.

🟦 Stroke can also cause slurred speech, but stroke speech deficits are typically sudden onset and often accompanied by other acute focal neurologic signs.

🟦 Since this client shows progressive bilateral Parkinsonian motor features (tremor, rigidity, facial masking), the speech changes most strongly support Parkinson disease as the primary condition.

Orientation status (initially oriented → later disoriented to date/time) → Parkinson disease (possible cognitive progression)

🟦 Parkinson disease can progress beyond motor symptoms and affect cognition, especially as the disease advances, leading to Parkinson-related cognitive impairment.

🟦 Being disoriented to date and time suggests decline in attention, executive function, and memory, which can occur in later stages.

🟦 The key clue is the gradual change over 6 months, which is consistent with a progressive neurologic condition rather than a sudden event.

🟦 Stroke can cause orientation problems, but that usually follows an acute neurologic insult and is often more abrupt and associated with other focal deficits.

🟦 MS may cause cognitive issues, but the client’s dominant pattern is classic Parkinson motor progression, making Parkinson the best fit for the orientation change in this clinical picture.

Facial rigidity and drooling → Parkinson disease

🟦 Facial rigidity is a classic Parkinson feature and appears as a mask-like face due to decreased facial expressiveness from bradykinesia and rigidity.

🟦 Drooling occurs because swallowing becomes less frequent and less coordinated, not because saliva production increases—this reflects impaired motor control.

🟦 These findings strongly support Parkinson because they reflect progressive involvement of cranial and facial muscle control.

🟦 Stroke can cause facial droop or asymmetry, but facial rigidity with drooling is more characteristic of Parkinsonian facial masking than acute focal weakness.

🟦 MS can affect swallowing, but the combined pattern of resting tremor + rigidity + facial masking + drooling is most consistent with Parkinson disease.