Last reviewed: 29 Jun 2021
Last updated: 06 May 2021

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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