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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 [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]
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“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
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“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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“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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“Bradykinesia, rigidity, tremor at rest, postural instability, micrographia and shuffling gait represent the principal motor symptoms that allow the diagnosis of PD (Jankovic, 2008).”
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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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“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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“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 pathological changes of the disease are degeneration of the substantia nigra and striatum pathway [2].”
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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The neural substrates of rapid-onset Dystonia-Parkinsonism
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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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Premotor, nonmotor and motor symptoms of Parkinson's Disease: A new clinical state of the art
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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].”
Metadata
- 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 › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- 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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