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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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Breasail, M. Ó., Biswas, B., Smith, M. D., Mazhar, M. K. A., Tenison, E., Cullen, A., Lithander, F. E., Roudaut, A., & Henderson, E. J. (2021) · Sensors · doi:10.3390/s21248261 · Cited by 71
Revisiting the Role of Astrocytic MAOB in Parkinson’s Disease
Nam, M., Sa, M., Ju, Y. H., Park, M. G., & Lee, C. J. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23084453 · Cited by 68
Artificial intelligence in Parkinson's disease: Early detection and diagnostic advancements
Reddy, A. P., Reddy, R. P., Roghani, A. K., Garcia, R. I., Khemka, S., Pattoor, V., Jacob, M., Reddy, P. H., & Sehar, U. (2024) · Ageing Research Reviews · doi:10.1016/j.arr.2024.102410 · Cited by 72
Management of constipation in Parkinson’s disease
Rossi, M., Merello, M., & Perez‐Lloret, S. (2014) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2015.997211 · Cited by 68
“It is mainly recognized by its cardinal motor signs: bradykinesia, rigidity, rest tremor and postural instability, although other secondary motor features, such as hypomimia, dysarthria, dysphagia, micrographia, shuffling gait, festination, freezing and dystonia, are also common [3].”
BackgroundImpaired implicit sequence learning in Parkinson's disease patients with freezing of gait.
Vandenbossche, J., Deroost, N., Soetens, E. L. L., Coomans, D., Spildooren, J., Vercruysse, S., Nieuwboer, A., & Kerckhofs, E. (2013) · Neuropsychology · doi:10.1037/a0031278 · Cited by 67
Eisbach, S. E., & Outeiro, T. F. (2013) · Journal of Molecular Medicine · doi:10.1007/s00109-013-1038-9 · Cited by 65
Ordemann, J. M., & Austin, R. N. (2015) · Metallomics · doi:10.1039/c5mt00300h · Cited by 67
Estimating the direct and indirect costs associated with Parkinson’s disease
Rodríguez‐Blázquez, C., Forjaz, M. J., Lizán, L., Paz, S., & Martínez‐Martín, P. (2015) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1586/14737167.2015.1103184 · Cited by 65
“KEYWORDS: Parkinson’s disease ● economic evaluation ● cost of illness ● cost–effectiveness ● QALYs Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease.[1] It is characterized by progressive increases in movement-related disability, including tremor, rigidity and brad…”
BackgroundLi, C., Huang, B., Zhang, R., Ma, Q., Yang, W., Wang, L., Wang, L., Xu, Q., Feng, J., Liu, L., et al. (2016) · Brain Imaging and Behavior · doi:10.1007/s11682-015-9501-6 · Cited by 65
“Parkinson’s disease (PD), a chronic neurodegenerative disease of the central nervous system, is clinically characterized by resting tremor, muscle rigidity, bradykinesia, and other abnormal postures and pace (Jankovic 2008; Lees et al. 2009).”
Neurovestibular analysis and falls in Parkinson's disease and atypical parkinsonism
Venhovens, J., Meulstee, J., Bloem, B. R., & Verhagen, W. I. M. (2016) · European Journal of Neuroscience · doi:10.1111/ejn.13253 · Cited by 65
Bel, E. A. D., Bortolanza, M., Pereira, M. D. S., Bariotto‐dos‐Santos, K., & Raisman‐Vozari, R. (2016) · Synapse · doi:10.1002/syn.21941 · Cited by 67
Diagnosis of Parkinson’s Disease using Fuzzy C-Means Clustering and Pattern Recognition
Rustempasic, I., & Can, M. (2013) · Southeast Europe Journal of Soft Computing · doi:10.21533/scjournal.v2i1.44 · Cited by 65
Lu, R., Wang, J., Tao, R. N., Wang, J., Zhu, T., Guo, W., Sun, Y., Li, H., Gao, Y., Zhang, W., et al. (2017) · Molecular Psychiatry · doi:10.1038/mp.2017.136 · Cited by 65
Nguyen, T. T. S., Dung, V. M., Huynh, M. A., Yamaguchi, M., Tran, T. L., & Thảo, Đ. T. P. (2018) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2018/2038267 · Cited by 68
Understanding cognitive deficits in Parkinson’s disease: lessons from preclinical animal modelsPreprint
Solari, N., Bonito-Oliva, A., Fisone, G., & Brambilla, R. (2013) · Learning & Memory · doi:10.1101/lm.032029.113 · Cited by 65
“However, PD also involves nonmotor symptoms (NMS) (Chaudhuri et al. 2006; Jankovic 2008) that appear in the early, oftenpremotor, phase of the disease (Abbott et al.”
Cebrián, C., Loike, J. D., & Sulzer, D. (2014) · Current Topics in Behavioral Neurosciences · doi:10.1007/7854_2014_356 · Cited by 65
“…by a progressive loss of dopamine (DA) releasing neurons in the substantia nigra (SN) pars compacta (SNc), resulting in slowness of movement, rigidity, and tremor (Jankovic 2008), as well as the death of neurons in other catecholaminergic and cholinergic nuclei (Sulzer and Surmeier 2013).”
Rowińska‐Żyrek, M., Salerno, M., & Kozłowski, H. (2014) · Coordination Chemistry Reviews · doi:10.1016/j.ccr.2014.03.026 · Cited by 66
Lee, H. K., Ahn, S. J., Shin, Y. M., Kang, N., & Cauraugh, J. H. (2019) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-019-0562-4 · Cited by 64
“The cardinal symptoms of PD are manifested as motor related features including bradykinesia, rigidity, resting tremor, postural instability, and gait disturbance [2].”
BackgroundCaenorhabditis elegans as a model system for studying aging-associated neurodegenerative diseases
Pelt, K. M. V., & Truttmann, M. C. (2020) · Translational Medicine of Aging · doi:10.1016/j.tma.2020.05.001 · Cited by 62
Pathological Gait Classification Using Kinect v2 and Gated Recurrent Neural Networks
Jun, K., Lee, Y., Lee, S., Lee, D.-W., & Kim, M. S. (2020) · IEEE Access · doi:10.1109/access.2020.3013029 · Cited by 64
Restoration and targeting of aberrant neurotransmitters in Parkinson's disease therapeutics
Yadav, D., & Kumar, P. (2022) · Neurochemistry International · doi:10.1016/j.neuint.2022.105327 · Cited by 63
Guo, Z., Zeng, W., Yu, T., Xu, Y., Xiao, Y., Cao, X., & Cao, Z. (2022) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2022.3162386 · Cited by 66
CRISPR-Cas9-Based Technology and Its Relevance to Gene Editing in Parkinson’s Disease
Rahman, M. U., Bilal, M., Shah, J. A., Kaushik, A. K., Teissèdre, P., & Kujawska, M. (2022) · Pharmaceutics · doi:10.3390/pharmaceutics14061252 · Cited by 65
Rahman, S., Hasan, M., Sarkar, A. K., & Khan, F. (2023) · European Journal of Electrical Engineering and Computer Science · doi:10.24018/ejece.2023.7.2.488 · Cited by 64
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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