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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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Tai, W., Ye, X., Bao, X., Zhao, B., Wang, X., & Zhang, D. (2013) · Neuropharmacology · doi:10.1016/j.neuropharm.2013.07.020 · Cited by 49
Pacheco, C., Aguayo, L. G., & Opazo, C. (2012) · Frontiers in Physiology · doi:10.3389/fphys.2012.00297 · Cited by 52
Diurnal and nocturnal drooling in Parkinson’s disease
Kalf, J. G., Bloem, B. R., & Munneke, M. (2011) · Journal of Neurology · doi:10.1007/s00415-011-6138-2 · Cited by 49
Reinhart, F., Massri, N. E., Chabrol, C., Crétallaz, C., Johnstone, D. M., Torres-Martinez, N., Darlot, F., Costecalde, T., Stone, J., Mitrofanis, J., et al. (2015) · Journal of neurosurgery · doi:10.3171/2015.5.jns15735 · Cited by 49
Gait in Parkinson’s disease: A visuo-cognitive challenge
Stuart, S., Lord, S., Hill, E., & Rochester, L. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.01.002 · Cited by 55
“Parkinson’s disease (PD) is a common neurodegenerative disorder characterised by cardinal motor symptoms such as rigidity, bradykinesia, tremor, postural instability and gait deficit (Jankovic, 2008).”
Roy, M. N., Saha, S., Kundu, M., Saha, B. C., & Barman, S. (2016) · Chemical Physics Letters · doi:10.1016/j.cplett.2016.05.031 · Cited by 49
Identification of a LargeDNAJB2Deletion in a Family with Spinal Muscular Atrophy and Parkinsonism
Sánchez, E., Darvish, H., Mesias, R., Taghavi, S., Firouzabadi, S. G., Walker, R. H., Tafakhori, A., & Paisán‐Ruiz, C. (2016) · Human Mutation · doi:10.1002/humu.23055 · Cited by 51
Synucleinopathies: common features and hippocampal manifestations
Yang, W., & Yu, S. (2016) · Cellular and Molecular Life Sciences · doi:10.1007/s00018-016-2411-y · Cited by 49
“The cardinal clinical manifestations are motor symptoms, including bradykinesia, rigidity, rest tremor, and postural and gait impairments [10], by which PD is diagnosed.”
Kasai, S., Yoshihara, T., Lopatina, O. L., Ishihara, K., & Higashida, H. (2017) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2017.00075 · Cited by 50
“Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms such as bradykinesia, rigidity, tremor at rest and postural instability, which arise mainly from dysfunction of the nigrostriatal dopaminergic pathway (Jankovic, 2008; Braak and Del Tredici, 2009).”
InfluentialCombined Active Humoral and Cellular Immunization Approaches for the Treatment of Synucleinopathies
Rockenstein, E. M., Ostroff, G. R., Dikengil, F., Rus, F., Mante, M., Florio, J. B., Adame, A., Trinh, I., Kim, C., Overk, C., et al. (2017) · Journal of Neuroscience · doi:10.1523/jneurosci.1170-17.2017 · Cited by 53
Neuroinflammation in l-DOPA-induced dyskinesia: beyond the immune function
Pisanu, A., Boi, L., Mulas, G., Spiga, S., Fenu, S., & Carta, A. R. (2018) · Journal of Neural Transmission · doi:10.1007/s00702-018-1874-4 · Cited by 49
Yazar, T., Yazar, H. O., Zayimoğlu, E., & Çankaya, S. (2018) · Neurological Sciences · doi:10.1007/s10072-018-3439-6 · Cited by 49
Varrecchia, T., Castiglia, S. F., Ranavolo, A., Conte, C., Tatarelli, A., Coppola, G., Lorenzo, C. D., Draicchio, F., Pierelli, F., & Serrao, M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0244396 · Cited by 49
Brain-targeted gene delivery of ZnO quantum dots nanoplatform for the treatment of Parkinson disease
Lin, D., Li, M., Gao, Y., Yin, L., & Guan, Y. (2021) · Chemical Engineering Journal · doi:10.1016/j.cej.2021.132210 · Cited by 49
Towards Identification of Hypomimia in Parkinson's Disease Based on Face Recognition Methods
Rajnoha, M., Mekyska, J., Bürget, R., Eliasova, I., Košťálová, M., & Rektorová, I. (2018) · International Congress on Ultra Modern Telecommunications and Control Systems and Workshops (ICUMT) · doi:10.1109/icumt.2018.8631249 · Cited by 50
The clinical meaning of levodopa equivalent daily dose in Parkinson's disease
Julien, C., Hache, G., Dulac, M., Dubrou, C., Castelnovo, G., Giordana, C., Azulay, J., & Fluchère, F. (2021) · Fundamental and Clinical Pharmacology · doi:10.1111/fcp.12646 · Cited by 51
Li, J., Long, Q., Ding, H., Wang, Y., Luo, D., Li, Z., & Zhang, W. (2024) · Advanced Science · doi:10.1002/advs.202308677 · Cited by 47
Machine Learning Models for Parkinson Disease: Systematic Review
Tabashum, T., Snyder, R. C., O’Brien, M. K., & Albert, M. V. (2024) · JMIR Medical Informatics · doi:10.2196/50117 · Cited by 57
Massri, N. E., Johnstone, D. M., Peoples, C. L., Moro, C., Reinhart, F., Torres-Martinez, N., Stone, J., Benabid, A., & Mitrofanis, J. (2014) · International Journal of Neuroscience · doi:10.3109/00207454.2014.994063 · Cited by 48
“Parkinson’s disease is a movement disorder with cardinal signs of resting tremor, akinesia, bradykinesia and rigidity [1,2].”
BackgroundGao, L., Li, C., Yang, R., Lian, W., Fang, J., Pang, X., Qin, X., Liu, A., & Du, G. (2015) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2015.04.004 · Cited by 48
Epigenetics-Based Therapeutics for Neurodegenerative Disorders
Xu, Z., Li, H., & Jin, P. (2012) · Current Geriatrics Reports · doi:10.1007/s13670-012-0027-0 · Cited by 49
Is Irish set dancing feasible for people with Parkinson's disease in Ireland?
Shanahan, J., Morris, M. E., Bhriain, O. N., Volpe, D., Richardson, M., & Clifford, A. M. (2014) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2014.12.002 · Cited by 48
Lindenbach, D., Ostock, C. Y., Jaunarajs, K. L. E., Dupre, K. B., Barnum, C. J., Bhide, N., & Bishop, C. (2011) · Journal of Pharmacology and Experimental Therapeutics · doi:10.1124/jpet.111.179416 · Cited by 48
“For the last half-century, the DA precursor L-DOPA has been the treatment of choice for PD, even though its chronic use induces side effects that can be as debilitating as PD itself (Jankovic, 2008).”
Nilsson, M. H., Patel, M., Rehncrona, S., Magnusson, M., & Fransson, P.-A. (2013) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/1743-0003-10-33 · Cited by 48
Özsoy, Ö., Yıldırım, F. B., Ogut, E., Kaya, Y., Tanriover, G., Parlak, H., Ağar, A., & Aslan, M. (2015) · Free Radical Research · doi:10.3109/10715762.2015.1027198 · Cited by 48
Telerreabilitação vocal na doença de Parkinson
Dias, A. E., Limongi, J. C. P., Barbosa, E. R., & Hsing, W. T. (2016) · CoDAS · doi:10.1590/2317-1782/20162015161 · Cited by 49
Continuous Monitoring of Essential Tremor Using a Portable System Based on Smartwatch
Zheng, X., Vieira Campos, A., Ordieres-Meré, J., Balseiro, J., Labrador Marcos, S., & Aladro, Y. (2017) · Frontiers in Neurology · doi:10.3389/fneur.2017.00096 · Cited by 44
Boroojerdi, B., Ghaffari, R., Mahadevan, N., Markowitz, M., Melton, K., Morey, B., Otoul, C., Patel, S., Phillips, J., Sen-Gupta, E., et al. (2019) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2018.11.024 · Cited by 43
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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