Parkinson's disease: clinical features and diagnosis
Open accessAbstract
OBJECTIVE: Parkinson's disease (PD) is a progressive neurological disorder characterised by a large number of motor and non-motor features that can impact on function to a variable degree. This review describes the clinical characteristics of PD with emphasis on those features that differentiate the disease from other parkinsonian disorders. METHODS: A MedLine search was performed to identify studies that assess the clinical characteristics of PD. Search terms included "Parkinson's disease", "diagnosis" and "signs and symptoms". RESULTS: Because there is no definitive test for the diagnosis of PD, the disease must be diagnosed based on clinical criteria. Rest tremor, bradykinesia, rigidity and loss of postural reflexes are generally considered the cardinal signs of PD. The presence and specific presentation of these features are used to differentiate PD from related parkinsonian disorders. Other clinical features include secondary motor symptoms (eg, hypomimia, dysarthria, dysphagia, sialorrhoea, micrographia, shuffling gait, festination, freezing, dystonia, glabellar reflexes), non-motor symptoms (eg, autonomic dysfunction, cognitive/neurobehavioral abnormalities, sleep disorders and sensory abnormalities such as anosmia, paresthesias and pain). Absence of rest tremor, early occurrence of gait difficulty, postural instability, dementia, hallucinations, and the presence of dysautonomia, ophthalmoparesis, ataxia and other atypical features, coupled with poor or no response to levodopa, suggest diagnoses other than PD. CONCLUSIONS: A thorough understanding of the broad spectrum of clinical manifestations of PD is essential to the proper diagnosis of the disease. Genetic mutations or variants, neuroimaging abnormalities and other tests are potential biomarkers that may improve diagnosis and allow the identification of persons at risk.
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Most medical diagnoses rely on standardized guidelines.
“Most medical diagnoses rely on standardized guidelines [23, 26, 60].”
From Understanding the Effect of Counterfactual Explanations on Trust and Reliance on AI for Human-AI Collaborative Clinical Decision Making (2023) · cites this paper as [26]
The “Assessment of Patients with PD—Diagnostic criteria” section (page not provided) says Parkinson’s disease is diagnosed using clinical criteria and describes two published sets of diagnostic criteria. It does not establish that most medical diagnoses, across conditions, rely on standardized guidelines. (LLM, conf=0.84)
Experimental — accuracy not yet measuredResting tremor that occurs in a fully supported arm serves as an important symptom in differentiating PD from ET in clinical diagnosis.
“Resting tremor that occurs in a fully supported arm serves as an important symptom in differentiating PD from ET in clinical diagnosis (Jankovic, 2008).”
From A Novel Posture for Better Differentiation Between Parkinson's Tremor and Essential Tremor (2018) · cites this paper as Jankovic, 2008
The Tremor section calls rest tremor a common symptom of PD, and Table 2 lists tremor increasing at rest in PD but decreasing at rest in essential tremor. The copy does not specify a fully supported arm as the examination condition, so that detail is unsupported. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAround 80% of Parkinson's disease patients have limb tremor, most commonly a resting pill-rolling type of tremor of the hands.
“Around 80% have limb tremor, most commonly a resting pill-rolling type of tremor of the hands.”
From The clinical symptoms of Parkinson's disease. (2016) · cites this paper as Jankovic 2008
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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“The loss of these neurons leads to significant motor and non-motor neurological dysfunction that define the clinical course of Parkinson’s disease [219].”
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Wearable Assistant for Parkinson’s Disease Patients With the Freezing of Gait Symptom
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“The motor symptoms appear when at least 60% of dopaminergic neurons are lost and 80–85% of dopamine content in the striatum is depleted (Jankovic, 2008; Wirdefeldt et al., 2011).”
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“Other motor features include gait and posture changes that manifest as festination (rapid shuffling steps with a forward-flexed posture when walking), speech and swallowing difficulties, and a masklike facial expression and micrographia [58].”
Collection and Analysis of a Parkinson Speech Dataset With Multiple Types of Sound Recordings
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“PARKINSON’s disease (PD) is a neurodegenerative disorder of central nervous system that causes partial or full loss in motor reflexes, speech, behavior, mental processing, and other vital functions [1].”
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“Tremor at rest, rigidity, akinesia/bradykinesia and postural instability are the four cardinal features in Parkinson’s disease [60].”
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“Early symptoms may include sleep and associated disorders such as, mild tremors, soft speech, postural difficulty, impairments in normal facial expressions, reduced limb movement, focus loss, general fatigue and depression without any obvious cause [17].”
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“Secondary symptoms may include high level cognitive dysfunctions and subtle language problems [84].”
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Aberrations in Peripheral Inflammatory Cytokine Levels in Parkinson Disease
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“The following exclusion criteria were applied: (1) in vitro studies that reported stimulated or unstimulated levels of cytokines; (2) samples overlapped with other studies; (3) patients were not diagnosed with PD at the time of blood sampling; and (4) the cytokine analyzed was assessed in fewer than 3 studies.”
Engineered In Vitro Disease Models
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“The symptoms result from the death of dopamine-generating cells in a brain region called the substantia nigra, possibly initiated by the abnormal accumulation of α-synuclein protein in the form of Lewy bodies (322, 329).”
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“PD is characterized by four major clinical features: (a) rest tremor of a limb; (b) slowness of movement; (c) rigidity of the limbs or trunk; and (d) poor balance”
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Dysphagia in Parkinson’s Disease
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Parkinson’s disease induced pluripotent stem cells with triplication of the α-synuclein locus
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“6 than adequately covered in other reviews (Helmich, Hallett, Deuschl, Toni, & Bloem, 2012; Jankovic, 2008).”
InfluentialNeuropathology of sporadic Parkinson's disease: Evaluation and changes of concepts
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Priorities in Parkinson's disease research
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“Among these symptoms, bradykinesia, resting tremors and rigidity are the core features of P”
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“In the majority of patients, these two main synucleinopathies are easy to differentiate clinically by the predominance of extrapyramidal motor features in patients with PD [76] and dementia in DLB [108]; however, in some patients, dementia and extrapyramidal signs occur in close succession, prompting debate about thei…”
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“Parkinsonian patients tend to adopt a stooped posture (see online Movie 7 at www.perspectivesinmedicine.org), owing to the loss of postural reflexes, a major contributor to falls (Edwards et al. 2008a; Jankovic 2008; Sethi 2008).”
InfluentialThe involvement of BDNF, NGF and GDNF in aging and Alzheimer's disease
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“PD is a progressive neurological disorder associated with motor and non-motor features (Jankovic, 2008) which comprises multiple aspects of movements, including planning, initiation and execution (Contreras-Vidal and Stelmach, 1995).”
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“PD is primarily a movement disorder characterized by rest tremor, bradykinesia, rigidity, and loss of postural reflexes (Jankovic, 2008).”
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“Because the dopaminergic projections from the substantia nigra are crucially involved in the initiation of motor events, PD is mainly known for symptoms such as tremor, rigidity, bradykinesia, and gait disturbances (Jankovic, 2008).”
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“Bradykinesia, rigidity, rest tremor, and postural instability are the hallmark features of the disease and have a negative impact upon movement quality, gait and balance performance, and fall risk (Canning 2014; Jankovic 2008).”
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“PD is a progressive neurodegenerative disease with multiple motor and non-motor characteristics [2].”
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“The four cardinal symptoms of this disease are tremor, rigidity, postural problems, and inability to initiate voluntary movements (akinesia), which eventually leads to paralysis (Jankovic, 2008).”
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“Istradefylline, a novel adenosine antagonist, has been also reported to provide modest benefi t in PD patients with levodopa-related motor complications (Jankovic 2008b).”
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“Early-onset Parkinsonism (EOP) is characterized by the presentation at a young age of tremor, hypokinesia, muscular rigidity, and postural instability [Jankovic, 2008].”
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Curcumin: A Potential Neuroprotective Agent in Parkinson's Disease
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“motor impairment in PD are bradykinesia, resting tremor, rigidity, and postural instability [19].”
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Alpha‐Synuclein as a Biomarker for Parkinson's Disease
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“However, chronic treatment with L -DOPA results in the development of adverse effects such as dyskinesia , and treatment becomes less effective with time because neurons continue to degenerat”
The Therapeutic Potential of Metformin in Neurodegenerative Diseases
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“PD is characterized by bradykinesia and a combination of rigidity, resting tremor, postural instability, and a large range of non-motor symptoms (110).”
Dopamine enhances willingness to exert effort for reward in Parkinson's disease
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“The accompanying dopaminergic depletion is traditionally considered one of the underlying mechanisms that contributes to the cardinal motor symptoms of bradykinesia, rigidity and tremor (Jankovic, 2008).”
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“Currently, diagnosis of PD is based on the presence of clinical motor symptoms 6 , which are estimated to develop after 50–80% of dopaminergic neurons have already degenerated 43 .”
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Molecular Mechanisms behind Free Radical Scavengers Function against Oxidative Stress
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Microglial phagocytosis of neurons in neurodegeneration, and its regulation
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“The pathological changes of the disease are degeneration of the substantia nigra and striatum pathway [2].”
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Synaptic Dysfunction in Parkinson’s Disease
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“Bradykinesia, rigidity, tremor at rest, postural instability, micrographia and shuffling gait represent the principal motor symptoms that allow the diagnosis of PD (Jankovic, 2008).”
Deep 1D-Convnet for accurate Parkinson disease detection and severity prediction from gait
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“Gait analysis is an important step in the diagnosis process of Parkinson’s disease (Jankovic, 2008)(Reich and Savitt, 2019), as gait abnormalities have been documented to occur at the early stages (Pistacchi et al., 2017).”
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Oxidative Stress in Parkinson's Disease: A Systematic Review and Meta-Analysis
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“Parkinson’s disease is attributed to the death of dopaminergic neurons of the substantia nigra pars compacta (Jankovic, 2008), a brainstem nucleus projecting to virtually all of the basal ganglia.”
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Oligomeric and phosphorylated alpha-synuclein as potential CSF biomarkers for Parkinson’s disease
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Integrating Pathways of Parkinson's Disease in a Molecular Interaction Map
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Neuroprotective effect of metformin in MPTP-induced Parkinson’s disease in mice
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“Parkinson s disease (PD) is typically known for the loss of nigrostriatal dopaminergic neurons associated with motor impairment, of which muscle rigidity, resting tremor, bradykinesia, and postural instability are the cardinal symptoms (Jankovic, 2008).”
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Shaping the Nrf2-ARE-related pathways in Alzheimer’s and Parkinson’s diseases
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The role of Toll-like receptors and neuroinflammation in Parkinson’s disease
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“The loss of dopaminergic neurons in PD leads to motor dysfunction accompanied by progressive non-motor symptoms, which include cognitive impairments, mood disturbances, sleep dysfunction, gastrointestinal problems, and dysautonomia [3-5].”
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“Parkinson’s Disease Parkinson’s disease, while characterized by motor deficits, produces impairments in working memory, attention, and a two to six times higher risk of dementia (153, 154).”
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“Patients with PD are usually characterized by five symptoms including tremor, rigidity, bradykinesia or slowness of movement, hand asymmetry and posture instability [5, 6].”
BackgroundAlpha-Synuclein Aggregation in Parkinson's Disease
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Prussian Blue Nanozyme as a Pyroptosis Inhibitor Alleviates Neurodegeneration
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Glutamate Receptors as Therapeutic Targets for Parkinsons Disease
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“symptoms including bradykinesia, tremor, rigidity, postural instability, and gait disturbances, as well as nonmotor symptoms such as sleep disturbance and cognitive impairment [4].”
- Authors
- Jankovic, J.
- Affiliations
- Baylor College of Medicine (US)
- Corresponding author
- Jankovic, J
- ORCID
- Jankovic, J
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 2008-04-01
- Volume
- 79
- Issue
- 4
- Pages
- 368-376
- ISSN
- 0022-3050 (ISSN-L)
- OpenAlex
- W2145954079
- Cited by
- 5,720
- References
- 157
- Citations by year
- 2026: 307 · 2025: 455 · 2024: 503 · 2023: 422 · 2022: 424 · 2021: 444 · 2020: 455 · 2019: 405 · 2018: 349 · 2017: 323 · 2016: 324 · 2015: 298 · 2014: 257 · 2013: 232 · 2012: 184
- FWCI
- 15.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Parkinson Foundation
- Parkinsonfonden
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- Parkinson's disease, clinical features, diagnosis, parkinsonism, resting tremor, bradykinesia, rigidity, postural instability, non-motor symptoms, autonomic dysfunction, levodopa response, differential diagnosis, biomarkers, genetic mutations, neuroimaging
- MeSH terms
- Diagnosis, Differential, Humans, Neurologic Examination, Parkinson Disease, Parkinsonian Disorders
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