Last reviewed:October 2019
Last updated:October  2019

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 (manganese, iron)
  • male sex
  • additional genetic risk factors
  • head trauma
  • geographic influence
  • toxin exposure
  • occupation as a teacher, healthcare provider, construction worker, carpenter, or cleaner

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)
Full details

Emerging tests

  • sonography, basal ganglia
  • cardiac sympathetic innervation using iodine-123 meta-iodobenzylguanidine (MIBG)
Full details

Treatment algorithm

Contributors

Department of Neurology

Division of Movement Disorders

Northwestern University Feinberg School of Medicine

Chicago

IL 

Disclosures

AF declares that he has no competing interests.

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.

Peer reviewersVIEW ALL

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.

Assistant Professor of Neurology

Jefferson Medical College

Thomas Jefferson University

Philadelphia

PA

Disclosures

DK declares that he has no competing interests.

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.

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.

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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