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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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“However, severe ‘on medication’ FOG/PI as a dominant issue is unusual in PD and raises the question of atypical pathologies such as vascular disease and tauopathy.(16) 17 Therefore, in the absence of a definitive test in life, we prefer to consider that patients in this study had the syndrome of parkinsonism and sever…”
Backgroundl ‐DOPA‐induced dyskinesia and neuroinflammation: do microglia and astrocytes play a role?
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“Regrettably, long-term L-DOPA therapy results in the development of motor complications including motor fluctuations termed ‘on-off’, ‘wearing off’, and L-DOPA-induced dyskinesia (LID) (Jankovic, 2008).”
The cortical signature of symptom laterality in Parkinson's disease
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Miranda, B. R. D., Castro, S. L., Rocha, E. M., Bodle, C., Johnson, K. E., & Greenamyre, J. T. (2021) · Neurobiology of Disease · doi:10.1016/j.nbd.2021.105312 · Cited by 75
Emotion Recognition From Gait Analyses: Current Research and Future Directions
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“In clinical terms, apart from the detection of movement abnormalities, observation of gait patterns also provides diagnostic clues for multiple neurological disorders such as cerebral palsy, Parkinson’s disease, and Rett syndrome [1], [2], [3], [4] in an early stage.”
Classification and staging of Parkinson's disease using video-based eye tracking
Brien, D. C., Riek, H. C., Yep, R., Huang, J. C. H., Coe, B. C., Areshenkoff, C. N., Grimes, D., Jog, M., Lang, A. E., Marras, C., et al. (2023) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2023.105316 · Cited by 75
NSAID use and risk of Parkinson disease: a population‐based case‐control study
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Lee, E. H., & Seo, S. R. (2014) · BMB Reports · doi:10.5483/bmbrep.2014.47.7.086 · Cited by 75
“neurons in the substantia nigra (SN) (56).”
The effects of dual tasking on handwriting in patients with Parkinson’s disease
Broeder, S., Nackaerts, E., Nieuwboer, A., Smits-Engelsman, B. C. M., Swinnen, S. P., & Heremans, E. (2014) · Neuroscience · doi:10.1016/j.neuroscience.2014.01.019 · Cited by 75
Lewis, C. J., Maier, F., Horstkötter, N., Zywczok, A., Witt, K., Eggers, C., Meyer, T. D., Dembek, T. A., Maarouf, M. M., Moro, E., et al. (2014) · Psychological Medicine · doi:10.1017/s0033291714001081 · Cited by 75
“Parkinson’s disease (PD) is a progressive neurological disorder accompanied by various motor impairments such as tremor, rigidity and akinesia (Jankovic, 2008), and non-motor impairments, such as autonomic and sensory impairments and neuropsychiatric disturbances (Löhle et al.”
Beall, E. B., Lowe, M. J., Alberts, J. L., Frankemolle‐Gilbert, A. M., Thota, A. K., Shah, C., & Phillips, M. D. (2013) · Brain Connectivity · doi:10.1089/brain.2012.0104 · Cited by 75
Parkinson's disease: chameleons and mimics
Ali, K., & Morris, H. R. (2014) · Practical Neurology · doi:10.1136/practneurol-2014-000849 · Cited by 75
A block to pre-prepared movement in gait freezing, relieved by pedunculopontine nucleus stimulation
Thevathasan, W., Pogosyan, A. H., Hyam, J. A., Jenkinson, N., Bogdanovic, M., Coyne, T. J., Silburn, P. A., Aziz, T. Z., & Brown, P. (2011) · Brain · doi:10.1093/brain/awr131 · Cited by 75
“Severe ‘ON medication’ freezing of gait/postural instability as a dominat- ing complaint in Parkinson’s disease is unusual and itself flags the possibility of progressive supranuclear palsy (Jankovic, 2008).”
InfluentialUnconstrained detection of freezing of Gait in Parkinson's disease patients using smartphone
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Deficits in the Mimicry of Facial Expressions in Parkinson's Disease
Livingstone, S. R., Vezer, E., McGarry, L. M., Lang, A. E., & Russo, F. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.00780 · Cited by 75
“One of the four cardinal symptoms of PD is akinesia, a loss of movement affecting the body and face (Berardelli et al., 2001; Davie, 2008; Jankovic, 2008).”
Decreased circulating Zinc levels in Parkinson’s disease: a meta-analysis study
Du, K., Liu, M., Zhong, X., & Wei, M. (2017) · Scientific Reports · doi:10.1038/s41598-017-04252-0 · Cited by 75
Melatonin as a mitochondrial protector in neurodegenerative diseases
Wongprayoon, P., & Govitrapong, P. (2017) · Cellular and Molecular Life Sciences · doi:10.1007/s00018-017-2614-x · Cited by 76
Parkinson Disease and Exercise
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Jankovic, J. J. (2010) · Movement Disorders · doi:10.1002/mds.23139 · Cited by 75
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Large-Scale Wearable Sensor Deployment in Parkinson’s Patients: The Parkinson@Home Study Protocol
Silva de Lima, A. L., Hahn, T., de Vries, N. M., Cohen, E., Bataille, L., Little, M. A., Baldus, H., Bloem, B. R., & Faber, M. J. (2016) · JMIR Research Protocols · doi:10.2196/resprot.5990 · Cited by 63
“There is a pressing need for collection of reliable medical information from PD patients while they perform activities of daily living, due to gaps in knowledge as to why different patients have variable rates of PD progression and different patterns of symptoms [31,32].”
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Review: The future of cell therapies and brain repair: P arkinson's disease leads the way
Petit, G. H., Olsson, T. T., & Brundin, P. (2013) · Neuropathology and Applied Neurobiology · doi:10.1111/nan.12110 · Cited by 74
Timed Up and Go evaluation with wearable devices: Validation in Parkinson's disease
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“These types are categorized as cognition, behavior, thought, and mood [5].”
Is insulin-like growth factor-1 involved in Parkinson’s disease development?
Castilla‐Cortázar, I., Aguirre, G. A., Femat‐Roldán, G., Martín‐Estal, I., & Espinosa, L. (2020) · Journal of Translational Medicine · doi:10.1186/s12967-020-02223-0 · Cited by 76
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Fu, X., Wang, Y., He, X., Li, H., Liu, H., & Zhang, X. (2020) · Lipids in Health and Disease · doi:10.1186/s12944-020-01284-w · Cited by 75
14-3-3 Proteins: Novel Pharmacological Targets in Neurodegenerative Diseases
Pair, F. S., & Yacoubian, T. A. (2021) · Trends in Pharmacological Sciences · doi:10.1016/j.tips.2021.01.001 · Cited by 74
Multi-Scale Sparse Graph Convolutional Network For the Assessment of Parkinsonian Gait
Guo, R., Shao, X., Zhang, C., & Qian, X. (2021) · IEEE Transactions on Multimedia · doi:10.1109/tmm.2021.3068609 · Cited by 74
Priya, S., Rani, P. A. J., Subathra, M. S. P., Mohammed, M. A., Damaševičius, R., & Ubendran, N. (2021) · Diagnostics · doi:10.3390/diagnostics11081395 · Cited by 74
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A pilot study to evaluate multi-dimensional effects of dance for people with Parkinson's disease
Ventura, M. I., Barnes, D. E., Ross, J. M., Lanni, K. E., Sigvardt, K. A., & Disbrow, E. A. (2016) · Contemporary Clinical Trials · doi:10.1016/j.cct.2016.10.001 · Cited by 82
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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