Parkinson disease (PD) is a chronic progressive neurologic disorder characterized by the presence of bradykinesia with at least one of rest tremor or rigidity.
It has an insidious, often asymmetric, onset.
PD is associated with numerous, often disabling, nonmotor symptoms.
Diagnosis is made clinically, based on history and neurologic exam.
Treatment is symptomatic and should be personalized, and involves multidisciplinary care to address both motor and nonmotor symptoms and improve quality of life.
Idiopathic Parkinson disease (PD) is a neurodegenerative disorder. The cardinal features of PD are the presence of bradykinesia with at least one of rest tremor or rigidity. Supportive criteria include a clear response to dopaminergic therapy and the presence of levodopa-induced dyskinesia. Patients also demonstrate a variety of nonmotor symptoms.
History and exam
Key diagnostic factors
- resting tremor
- postural instability
Other diagnostic factors
- masked facies
- hypokinetic dysarthria
- stooped posture
- shuffling gait
- conjugate gaze disorders
- exposure to antipsychotics or antiemetics
- features of atypical parkinsonism
- sleep disorders
- increasing age
- history of familial PD in younger-onset disease
- mutation in gene encoding glucocerebrosidase
- 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) exposure
- chronic exposure to metals
- male sex
- additional genetic risk factors
- head trauma
- geographic influence
- toxin exposure
1st investigations to order
- dopaminergic agent trial
Investigations to consider
- MRI brain
- functional neuroimaging (dopamine transporter imaging such as FP-CIT or beta-CIT SPECT, or fluorodopa PET)
- olfactory testing
- genetic testing
- neuropsychometric testing
- serum ceruloplasmin
- 24-hour urine copper
- cardiac sympathetic innervation using iodine-123 meta-iodobenzylguanidine (MIBG)
- brain pathology (postmortem)
- skin biopsy
- Essential tremor
- Progressive supranuclear palsy (PSP)
- Multiple system atrophy (MSA; MSA-A, formerly Shy-Drager syndrome; MSA-P, striatonigral degeneration; MSA-C, olivopontocerebellar atrophy)
- ACR–ACNM–SNMMI practice parameter for the performance of dopamine transporter (DaT) single photon emission computed tomography (SPECT) imaging for movement disorders
- European Academy of Neurology/Movement Disorder Society - European Section guideline on the treatment of Parkinson's disease: I. Invasive therapies
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