Clinical case · Parkinsonism
Falling after lunch and seeing children in the room
A 76-year-old man with Parkinson's disease for eight years is falling and seeing things that are not there. Untangle orthostatic hypotension, psychosis and cognitive decline, and treat them step by step without making his parkinsonism worse.
Advanced 20 minNeeds clinical reviewPro · free in beta
You will learn to
- Diagnose orthostatic hypotension with an active standing test and treat it in steps
- Manage psychosis in Parkinson's disease stepwise, starting with triggers and anticholinergic or sedative drugs
- Avoid harmful choices: anticholinergic antiparkinsonian drugs, dopamine-blocking antipsychotics and abrupt withdrawal of dopaminergic treatment
Presentation
Step 1 of 10A 76-year-old man with Parkinson's disease comes to clinic with his wife. He has fallen three times in two months, each time soon after getting up — twice after lunch.
For six weeks he has been seeing children and a dog in the living room in the evenings. "Last week he was frightened and said strangers were in the house," his wife says. "I'm exhausted."
References
- Höglinger G, Trenkwalder C; German Parkinson's Guidelines Committee. Diagnosis and treatment of Parkinson's disease (guideline of the German Society for Neurology). Neurol Res Pract. 2024;6:30. doi:10.1186/s42466-024-00325-4 · PubMed 38845028
Last updated 2026-10-21.
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