AI Scribe for
Parkinson's Disease

A complete Parkinson's disease visit note captures: current motor symptoms (tremor, rigidity, bradykinesia, postural instability) with quantified severity; non-motor symptoms (cognitive changes, autonomic dysfunction, sleep disturbances, mood); the patient's 'on' and 'off' states and the duration and character of each; current medication regimen including levodopa formulation, dopamine agonists, and adjunctive therapies; and the patient's functional status including falls, driving status, and ability to perform activities of daily living.

Medication management in Parkinson's is particularly documentation-intensive: dose changes and their rationale, the timing of medications relative to 'on/off' cycles, side effects at each dose, and the patient's response to changes must all be recorded to guide future management.

As disease advances, documentation must evaluate for and record the presence of motor complications (wearing off, dyskinesias) and consider referral criteria for advanced therapies including deep brain stimulation, levodopa-carbidopa intestinal gel, or focused ultrasound.

The Unified Parkinson's Disease Rating Scale (UPDRS) — and its current version, the MDS-UPDRS — provides a standardized measure of Parkinson's disease severity across motor and non-motor domains. Recording UPDRS scores consistently across visits permits meaningful tracking of disease progression and treatment response.

Part III of the MDS-UPDRS (motor examination) should be performed during the visit and the score recorded, along with whether the patient was examined in the 'on' or 'off' state. This distinction is essential: a patient examined in the 'off' state will score significantly higher than the same patient examined in the 'on' state, and the documentation must reflect which state was examined.

Structured UPDRS documentation also supports prior authorization for advanced therapies, including deep brain stimulation, where payer requirements typically include documented UPDRS Part III scores and 'on/off' response to medication.

Non-motor symptoms of Parkinson's disease — cognitive impairment, psychosis, depression, anxiety, REM sleep behavior disorder, autonomic dysfunction, and pain — are often the most disabling features of the disease in its later stages and the most commonly underdocumented.

Each non-motor domain should be systematically assessed and documented at regular intervals. Cognitive testing — even brief screening with MoCA or MMSE — should be performed and recorded annually or when new cognitive complaints arise. Neuropsychiatric symptoms must be documented not just as present or absent but with severity and impact on daily function.

Documentation of non-motor symptoms directly affects both clinical management and coding: a visit that addresses multiple non-motor symptom domains alongside motor management involves significantly more complex medical decision-making than a visit addressing only motor symptoms.