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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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Self-citationThe progression of Parkinson disease
Lang, A. E. (2007) · Neurology · doi:10.1212/01.wnl.0000257110.91041.5d · Cited by 116
Does This Patient Have Parkinson Disease?
Rao, G., Fisch, L., Srinivasan, S., D'Amico, F., Okada, T., Eaton, C., & Robbins, C. W. (2003) · JAMA · doi:10.1001/jama.289.3.347 · Cited by 115
Midbrain sonography in patients with essential tremor
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Interhemispheric and ipsilateral connections in Parkinson's disease: Relation to mirror movements
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Oral and genital pain syndromes in Parkinson's disease
Ford, B., Louis, E. D., Greene, P. E., & Fahn, S. (1996) · Movement Disorders · doi:10.1002/mds.870110411 · Cited by 110
Evaluation of a modified inverted walking stick as a treatment for Parkinsonian freezing episodes
Dietz, M. A., Goetz, C. G., & Stebbins, G. T. (1990) · Movement Disorders · doi:10.1002/mds.870050311 · Cited by 104
New developments of brain imaging for Parkinson's disease and related disorders
Piccini, P., & Brooks, D. J. (2006) · Movement Disorders · doi:10.1002/mds.20845 · Cited by 100
Ebersbach, G., Baas, H. K. J., Csóti, I., Müngersdorf, M., & Deuschl, G. (2006) · Journal of Neurology · doi:10.1007/s00415-006-4008-0 · Cited by 99
Diabetes mellitus and progression of rigidity and gait disturbance in older persons
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Neuropsychologic assessment of patients for movement disorder surgery
Saint‐Cyr, J. A., & Tr�panier, L. L. (2000) · Movement Disorders · doi:10.1002/1531-8257(200009)15:5 · Cited by 92
The relationship between parkinsonian rigidity and hypokinesia in the orofacial system
Hunker, C. J., Abbs, J. H., & Barlow, S. M. (1982) · Neurology · doi:10.1212/wnl.32.7.749 · Cited by 92
Parkinson's disease and driving ability
Singh, R. K., Pentland, B. T., Hunter, J., & Provan, F. (2006) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2006.103440 · Cited by 89
Parkinsonism and Neck Extensor Myopathy
Askmark, H., Eeg‐Olofsson, K. E., Johansson, A., Nilsson, P., Olsson, Y., & Aquilonius, S. (2001) · Archives of Neurology · doi:10.1001/archneur.58.2.232 · Cited by 88
Subjective Complaints Precede Parkinson Disease
de Lau, L. M. L., Koudstaal, P. J., Albert Hofman, D., & Breteler, M. M. B. (2006) · Archives of Neurology · doi:10.1001/archneur.63.3.noc50312 · Cited by 87
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Clarke, C. E. (2000) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.69.5.590 · Cited by 82
Lee, P. H., Yeo, S. H., Kim, H. J., & Youm, H. Y. (2006) · Movement Disorders · doi:10.1002/mds.21083 · Cited by 81
Phenomenology of dreams in Parkinson's disease
Borek, L. L., Kohn, R., & Friedman, J. H. (2006) · Movement Disorders · doi:10.1002/mds.21255 · Cited by 80
A new look at James Parkinson's Essay on the Shaking Palsy
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Response to L-DOPA in Multiple System Atrophy
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Nonmotor symptoms of Parkinson’s disease
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Akathisia in Parkinson's disease
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Modification of Parkinsonism???Chronic Treatment with L-Dopa
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Sweating in Parkinsonian patients with wearing‐off
Pursiainen, V., Haapaniemi, T., Korpelainen, J. T., Sotaniemi, K. A., & Myllylä, V. V. (2007) · Movement Disorders · doi:10.1002/mds.21422 · Cited by 66
Smell identification ability in twin pairs discordant for Parkinson's disease
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Contribution of Jules Froment to the study of Parkinsonian rigidity
Broussolle, E., Krack, P., Thobois, S., Xie‐Brustolin, J., Pollak, P., & Goetz, C. G. (2007) · Movement Disorders · doi:10.1002/mds.21484 · Cited by 65
Non-motor Symptoms of Parkinson's Disease
Hou, J. G., & Lai, E. C. (2007) · International journal of gerontology · doi:10.1016/s1873-9598(08)70024-3 · Cited by 63
Sheffield, J. K., & Jankovic, J. J. (2007) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.7.6.637 · Cited by 60
Self-citationRespiratory function in Parkinson's disease.
Shill, H. A., & Stacy, M. A. (1998) · PubMed · Cited by 56
The Metabolic Substrates of Bradykinesia and Tremor in Uncomplicated Parkinson's Disease
Lozza, C., Marié, R.-M., & Baron, J. (2002) · NeuroImage · doi:10.1006/nimg.2002.1245 · Cited by 56
Internal tremor in patients with Parkinson's disease
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Glabellar and palmomental reflexes in parkinsonian disorders
Brodsky, H., Vuong, K. D., Thomas, M., & Jankovic, J. J. (2004) · Neurology · doi:10.1212/01.wnl.0000140249.97312.76 · Cited by 51
Self-citationCognitive slowing in Parkinson disease is accompanied by hypofunctioning of the striatum
Sawamoto, N., Honda, M., Hanakawa, T., Aso, T., Inoue, M., Toyoda, H., Ishizu, K., Fukuyama, H., & Shibasaki, H. (2007) · Neurology · doi:10.1212/01.wnl.0000257821.28992.db · Cited by 46
Primitive reflexes in healthy, adult volunteers and neurological patients: methodological issues
Vreeling, F. W., JOLLES, J., Verhey, F. R. J., & Houx, P. J. (1993) · Journal of Neurology · doi:10.1007/bf00874119 · Cited by 44
Respiratory dyskinesia in Parkinson's disease
Jankovic, J. J., & Nour, F. (1986) · Neurology · doi:10.1212/wnl.36.2.303-b · Cited by 42
Self-citationPostural control in Parkinson's disease after unilateral posteroventral pallidotomy
Roberts-Warrior, D. (2000) · Brain · doi:10.1093/brain/123.10.2141 · Cited by 41
Camptocormia in Parkinson's disease: new insights
Djaldetti, R., & Melamed, E. (2006) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2006.099184 · Cited by 40
Blinking and the Release Reflexes: Are They Clinically Useful?
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Smooth pursuit during dose‐related on‐off fluctuations in Parkinson's disease
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Levodopa‐induced ocular dyskinesias in Parkinson's disease
Linazasoro, G., Blercom, N. V., Lasa, A., Indakoetxea, B., & Ruiz, J. (2002) · Movement Disorders · doi:10.1002/mds.10017 · Cited by 28
Camptocormia: Pathogenesis, classification, and response to therapy
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The frequency and significance of ‘striatal toe’ in parkinsonism
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Long-Term Follow-Up of Spontaneous Development in a Boy with Familial Male Precocious Puberty
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Ophthalmologic features of Parkinson's disease
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Depression Rating Scales in Parkinson’s Disease: Critique and Recommendations
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ARE PARKINSON DISEASE PATIENTS PROTECTED FROM SOME BUT NOT ALL CANCERS?
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Basal ganglia cholinergic and dopaminergic function in progressive supranuclear palsy
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THE PROGRESSION OF PARKINSON DISEASE: A HYPOTHESIS
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The Metabolic Substrates of Bradykinesia and Tremor in Uncomplicated Parkinson's Disease
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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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