Kwaliteitsstandaard atypische parkinsonismen

Pagina 225 0 No change in pattern of bowel function from previous pattern. 1 Occasional constipation but no medication needed. 2 Frequent constipation requiring use of laxatives. 3 Chronic constipation requiring use of laxatives and enemas. 4 Cannot have a spontaneous bowel movement. Total score Part I: Part II: Motor Examination Scale Always rate the worst affected limb. 1. Facial expression 0 Normal. 1 Minimal hypomimia, could be normal ( “ Poker face ” ). 2 Slight but definitely abnormal diminution of facial expression. 3 Moderate hypomimia; lips parted some of the time. 4 Masked or fixed facies with severe or complete loss of facial expression, lips parted 0.25 inch or more. 2. Speech The patient is asked to repeat several times a standard sentence. 0 Normal. 1 Mildly slow, slurred, and/or dysphonic. No need to repeat statements. 2 Moderately slow, slurred, and/or dysphonic. Sometimes asked to repeat statements. 3 Severely slow, slurred, and/or dysphonic. Frequently asked to repeat statements. 4 Unintelligible. 3. Ocular motor dysfunction Eye movements are examined by asking the subject to follow slow horizontal finger movements of the examiner, to look laterally at the finger at different positions, and to perform saccades between two fingers, each held at an eccentric posit ion of approximately 30°. The examiner assesses the following abnormal signs: (1) broken-up smooth pursuit, (2) gaze-evoked nystagmus at an eye position of more than 45 degrees, (3) gaze-evoked nystagmus at an eye position of less than 45 degrees, (4) saccadic hypermetria. Sign 3 suggests that there are at least two abnormal ocular motor signs, because Sign 2 is also present. 0 None. 1 One abnormal ocular motor sign. 2 Two abnormal ocular motor signs. 3 Three abnormal ocular motor signs. 4 Four abnormal ocular motor signs. 4. Tremor at rest (rate the most affected limb) 0 Absent. 1 Slight and infrequently present.