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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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Sterling, N. W., Cusumano, J. P., Shaham, N., Piazza, S. J., Liu, G., Kong, L., Du, G., Lewis, M. M., & Huang, X. (2015) · Journal of Parkinson s Disease · doi:10.3233/jpd-140447 · Cited by 54
Is Cell Death Primary or Secondary in the Pathophysiology of Idiopathic Parkinson’s Disease?
Schulz‐Schaeffer, W. (2015) · Biomolecules · doi:10.3390/biom5031467 · Cited by 54
Evaluation of a visual biofeedback on the postural control in Parkinson's disease
Caudron, S., Guerraz, M., Eusébio, A., Gros, J.-P., Azulay, J., & Vaugoyeau, M. (2013) · Neurophysiologie Clinique · doi:10.1016/j.neucli.2013.10.134 · Cited by 54
The Striatum and Pain Modulation
Barceló, A. C., Filippini, B., & Pazo, J. H. (2011) · Cellular and Molecular Neurobiology · doi:10.1007/s10571-011-9737-7 · Cited by 54
“For a long time, the basal ganglia have been related to motor functions since diseases affecting these structures lead to characteristic disturbances of movement and the muscles tone (Brooks 1995; Graybiel et al. 1994; Marsden and Obeso 1994; Wichmann and DeLong 2003; Jankovic 2008; Jeffery et al. 2007; Mahlon et al.…”
Clinical Characteristics of Exacerbations in Parkinson Disease
Zheng, K. S., Dorfman, B. J., Christos, P. J., Khadem, N. R., Henchcliffe, C., Piboolnurak, P., & Nirenberg, M. J. (2012) · The Neurologist · doi:10.1097/nrl.0b013e318251e6f2 · Cited by 54
Salivary DJ-1 could be an indicator of Parkinson's disease progression
Kang, W., Yang, Q., Jiang, X., Chen, W., Zhang, L., Wang, X., Zhang, L., Quinn, T. J., Liu, J., & Chen, S. (2014) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2014.00102 · Cited by 54
“Therefore, the identification of useful biomarkers to make an early diagnosis, or for monitoring progression, of PD is needed (Jankovic, 2008; Haas et al., 2012).”
Activity Recognition for Incomplete Spinal Cord Injury Subjects Using Hidden Markov Models
Sok, P., Xiao, T., Azeze, Y., Jayaraman, A., & Albert, M. V. (2018) · IEEE Sensors Journal · doi:10.1109/jsen.2018.2845749 · Cited by 54
Wang, J., Zhang, Y.-Q., Zhang, X., Wang, Y., Li, J.-P., & Li, Y. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.02.110 · Cited by 54
Role of Apolipoproteins and α-Synuclein in Parkinson’s Disease
Emamzadeh, F. N. (2017) · Journal of Molecular Neuroscience · doi:10.1007/s12031-017-0942-9 · Cited by 54
The effect of orexin-A on motor and cognitive functions in a rat model of Parkinson’s disease
Hadadianpour, Z., Fatehi, F., Ayoobi, F., Kaeidi, A., Shamsizadeh, A., & Fatemi, I. (2017) · Neurological Research · doi:10.1080/01616412.2017.1352185 · Cited by 54
“PD has a large number of motor and non-motor features and main symptoms include tremor at rest, rigidity, akinesia (or bradykinesia), and postural instability [3].”
Detecting neurodegenerative disorders from web search signals
White, R. W., Doraiswamy, P. M., & Horvitz, E. (2018) · npj Digital Medicine · doi:10.1038/s41746-018-0016-6 · Cited by 57
Boonying, W., Joselin, A. P., Huang, E., Qu, D., Safarpour, F., Iyirhiaro, G. O., González, Y. R., Callaghan, S. M., Slack, R. S., Figeys, D., et al. (2019) · Journal of Neurochemistry · doi:10.1111/jnc.14683 · Cited by 52
Update on the Management of Parkinson’s Disease for General Neurologists
Pirtošek, Z., Bajenaru, O. A., Kovács, N., Milanov, I. G., Relja, M., & Škorvánek, M. (2020) · Parkinson s Disease · doi:10.1155/2020/9131474 · Cited by 54
“Typical MS include hypomimia, dysarthria, dysphagia, decreased arm swing, shuffling gait, festinations, freezing, difficulty rising from a chair, difficulties with turning in bed, cutting food, feeding and hygiene, micrographia, presence of inexhaustible glabellar reflex, blepharospasm or other dystonia, and camptocor…”
Khachnaoui, H., Mabrouk, R., & Khlifa, N. (2020) · IET Image Processing · doi:10.1049/iet-ipr.2020.1048 · Cited by 57
“Classically, the PD diagnosis is based on clinical (motor and non-motor syndromes) and imaging evaluation [46, 47].”
Detection of Parkinson's Disease by Employing Boosting Algorithms
Nishat, M. M., Hasan, T., Nasrullah, S. M., Faisal, F., Asif, M. A.-A.-R., & Hoque, M. A. (2021) · International Conference on Informatics, Electronics & Vision (ICIEV) · doi:10.1109/icievicivpr52578.2021.9564108 · Cited by 53
MMDD-Ensemble: A Multimodal Data–Driven Ensemble Approach for Parkinson's Disease Detection
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Windolf, H., Chamberlain, R., Breitkreutz, J., & Quodbach, J. (2022) · Pharmaceutics · doi:10.3390/pharmaceutics14050931 · Cited by 54
Targeting mGluR2/3 for treatment of neurodegenerative and neuropsychiatric diseases
Li, S. H., Abd‐Elrahman, K. S., & Ferguson, S. S. G. (2022) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2022.108275 · Cited by 53
Nyatega, C. O., Qiang, L., Adamu, M. J., & Kawuwa, H. B. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1027907 · Cited by 53
Gut-brain axis and neurodegeneration: mechanisms and therapeutic potentials
Park, K. J., & Gao, Y. (2024) · Frontiers in Neuroscience · doi:10.3389/fnins.2024.1481390 · Cited by 63
Epigallocatechin-3-Gallate, a Promising Molecule for Parkinson's Disease?
Renaud, J., Nabavi, S. F., Daglia, M., Nabavi, S. M., & Martinoli, M. (2015) · Rejuvenation Research · doi:10.1089/rej.2014.1639 · Cited by 53
Wallach, I., Jaitly, N., & Lilien, R. (2010) · PLoS ONE · doi:10.1371/journal.pone.0012063 · Cited by 53
“Parkinson's disease (PD) is a progressive neurological disorder characterized by a large number of motor and non-motor features”
Shen, Y., & Niswender, C. M. (2014) · Cellular Signalling · doi:10.1016/j.cellsig.2014.04.022 · Cited by 63
The influence and the mechanism of docosahexaenoic acid on a mouse model of Parkinson’s disease
Özsoy, Ö., Seval, Y., Hacıoğlu, G., Yargıçoğlu, P., Demir, R., Ağar, A., & Aslan, M. (2011) · Neurochemistry International · doi:10.1016/j.neuint.2011.06.012 · Cited by 53
RETINA MEASUREMENTS FOR DIAGNOSIS OF PARKINSON DISEASE
García‐Martín, E., Satué, M., Otín, S., Fuertes, I., Alarcia, R., Larrosa, J. M., Polo, V., & Pablo, L. E. (2013) · Retina · doi:10.1097/iae.0000000000000028 · Cited by 55
“In addition, three or more of the following features during onset or evolution were required: unilateral onset, tremor at rest, progression over time, asymmetry of motor symptoms, response to levodopa for at least 5 years, clinical course of at least 10 years, and appearance of dyskinesias induced by the intake of exc…”
BackgroundKostoglou, K., Michmizos, K. P., Stathis, P. G., Sakas, D. E., Nikita, K. S., & Mitsis, G. D. (2016) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2016.2591827 · Cited by 53
“PARKINSON’S disease (PD) is a progressive neurodegenerative disorder that typically results in resting tremor, bradykinesia, rigidity, and postural instability [1].”
BackgroundKamińska, K., Lenda, T., Konieczny, J., Czarnecka, A. M., & Lorenc‐Koci, E. (2017) · Pharmacological Reports · doi:10.1016/j.pharep.2017.05.016 · Cited by 53
MicroRNAs and Target Genes As Biomarkers for the Diagnosis of Early Onset of Parkinson Disease
Arshad, A. R., Sulaiman, S. A., Saperi, A. A., Jamal, R., Ibrahim, N. M., & Murad, N. A. A. (2017) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2017.00352 · Cited by 54
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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