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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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Parkinson’s Disease Genes VPS35 and EIF4G1 Interact Genetically and Converge on α-Synuclein
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RetractedDiagnosis of Parkinson's Disease Based on Disease-Specific Autoantibody Profiles in Human Sera
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“The primary symptoms of PD include tremor, rigidity, bradykinesia, and postural instability [2].”
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Effects of Auditory Rhythm and Music on Gait Disturbances in Parkinson’s Disease
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The Function of Autophagy in Neurodegenerative Diseases
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“Patients with Parkinson’s disease show tremors, rigidity (muscle stiffness), akinesia (loss or impairment of voluntary movements), bradykinesia (slowness of movement), and postural instability [88].”
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Handwriting Analysis in Parkinson's Disease: Current Status and Future Directions
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Progression of tremor in early stages of Parkinson’s disease: a clinical and neuroimaging study
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“Parkinson’s disease (PD) is characterized by progressive motor deterioration and accumulation of non-motor symptoms including cognitive, psychiatric, and behavioral disturbances (1).”
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Postural Instability in Parkinson’s Disease: A Review
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“PI in PD is the inability to balance due to loss of postural reflexes [2]—specifically, balance reaction, adoption of a flexed posture, and trunk rotation [6].”
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“Autonomic dysfunction, cognitive dysfunction, and sleeping and sensory abnormalities, such as hyposmia, paresthesia, and chronic pain (Jankovic 2008), characterize the constellation of nonmotor clinical symptoms.”
BackgroundA spatiotemporal analysis of gait freezing and the impact of pedunculopontine nucleus stimulation
Thevathasan, W., Cole, M. H., Graepel, C. L., Hyam, J. A., Jenkinson, N., Brittain, J., Coyne, T. J., Silburn, P. A., Aziz, T. Z., Kerr, G., et al. (2012) · Brain · doi:10.1093/brain/aws039 · Cited by 162
“However, severe ON medication gait freezing as the predominant issue is unusual in Parkinson’s disease (Factor, 2008; Jankovic, 2008).”
Persistent organochlorine pesticides in serum and risk of Parkinson disease
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“Years to PD diagnosis, mean (SD) 22 (4) 16 (6) —”
Synaptic dysfunction in Parkinson's disease
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The major impact of freezing of gait on quality of life in Parkinson’s disease
Walton, C. C., Shine, J. M., Hall, J. M., O’Callaghan, C., Mowszowski, L., Gilat, M., Szeto, J. Y. Y., Naismith, S. L., & Lewis, S. J. G. (2014) · Journal of Neurology · doi:10.1007/s00415-014-7524-3 · Cited by 173
“Parkinson’s disease (PD) is a common neurodegenerative disorder [1] in which the combination of both motor and non-motor symptoms has a significant and negative impact on patients’ quality of life.”
Background
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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