Parkinsons
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Making a diagnosis of Parkinson's disease
A diagnosis of Parkinson's disease (PD) can be difficult as, in common with other central nervous system degenerative disorders, PD begins insidiously.
However, in the majority of cases the disease can be diagnosed based on the patient's history and physical findings.
Other possible causes of parkinsonian symptoms should be excluded, such as a history of repeated strokes with stepwise progression of parkinsonian features, head injury, encephalitis or neuroleptic treatment at onset of symptoms.
Clinical examination of a patient should focus on the presence or absence of the cardinal symptoms of PD, e.g. resting tremor, cogwheel rigidity, bradykinesia/akinesia and postural instability/impaired balance (Table 2).
If the outlined symptoms of PD are not evident, the patient should be re-examined at several-month intervals until PD or another disorder can be diagnosed.
A computerized tomography (CT) scan and/or magnetic resonance imaging (MRI) may help to exclude other neurological disorders.
In an attempt to aid diagnosis, the UK Parkinson's Disease Society Brain Bank recommends following a three-step approach to diagnosis, as summarised in Table 3.[19]
