Summary
Definition
History and exam
Key diagnostic factors
- bradykinesia
- resting tremor
- rigidity
- postural instability
Other diagnostic factors
- masked facies
- hypophonia
- hypokinetic dysarthria
- micrographia
- stooped posture
- shuffling gait
- conjugate gaze disorders
- fatigue
- constipation
- depression
- anxiety
- dementia
- exposure to neuroleptics or antiemetics
- features of atypical parkinsonism
Risk factors
- 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
- occupation
Diagnostic investigations
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
- brain pathology (postmortem)
Emerging tests
- sonography, basal ganglia
- cardiac sympathetic innervation using iodine-123 meta-iodobenzylguanidine (MIBG)
Treatment algorithm
Contributors
Authors
Avram Fraint, MD, MS
Department of Neurology
Division of Movement Disorders
Northwestern University Feinberg School of Medicine
Chicago
IL
Disclosures
AF declares that he has no competing interests.
Acknowledgements
Dr Avram Fraint would like to gratefully acknowledge Dr Danny Bega, Dr Meredith Spindler, Dr Jayne R. Wilkinson, and Dr Andrew D. Siderowf, the previous contributors to this topic.
Disclosures
DB served on the speaker's bureau for Teva Pharmaceuticals, and ACADIA Pharmaceutical, Inc; he has received consultancy fees from US WorldMeds and grant support from the Parkinson Foundation; he was on the board of directors for Rock Steady Boxing Windy City. MS, JRW, and ADS declare that they have no competing interests.
Peer reviewers
Graham A. Glass, MD
Assistant Clinical Professor
Department of Neurology
UCSF Medical Center
Parkinson's Disease Research
Education and Clinical Center
San Francisco
CA
Disclosures
GAG declares that he has no competing interests.
Daniel Kremens, MD, JD
Assistant Professor of Neurology
Jefferson Medical College
Thomas Jefferson University
Philadelphia
PA
Disclosures
DK declares that he has no competing interests.
Donald Grosset, BSc (Honours), MB, ChB, MD, FRCP
Consultant Neurologist / Honorary Senior Lecturer
Institute of Neurological Sciences
Southern General Hospital / University of Glasgow
Glasgow
UK
Disclosures
DG is an author of a reference cited in this topic.
Patricia Dowsey Limousin, MD, PhD
Reader in Clinical Neurology
Honorary Consultant
Institute of Neurology
National Hospital for Neurology and Neurosurgery
London
UK
Disclosures
PDL declares that she has no competing interests.
Nikolaus McFarland, MD, PhD
Assistant Professor
Department of Neurology
University of Florida College of Medicine
Gainesville
FL
Disclosures
NM declares that he has no competing interests.
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