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March 6, 1996

A 61-Year-Old Man With Parkinson's Disease

JAMA. 1996;275(9):716-722. doi:10.1001/jama.1996.03530330060031

Dr Delbanco: Dr H, a 61-year-old dentist, was diagnosed with Parkinson's disease (PD) in August 1990 by one of his patients, a neurologist, who noticed a change in his gait and difficulty in swallowing and speech. There was no tremor. Married and the father of three children living close to his home in the Boston, Mass, suburbs, Dr H has individual health insurance through a private managed care plan.

Dr H's patient encouraged him to seek a formal opinion, and a consulting neurologist confirmed that Dr H had PD; his condition was considered to be in the early stages. In retrospect, his primary care doctor, Dr C, now believes that earlier episodes of drooling and voice changes were due to PD. Of note in his medical history is mild hypertension and a resection of a right frontal meningioma in 1978, which has not recurred and left no neurologic residua. His