Parkinson's Disease

Diagnosis

Since there is no specific test or biomarker for PD, diagnosis depends on the presence of at least two of the three cardinal motor signs: tremor at rest, rigidity, and bradykinesia, and absence of a secondary cause such as neuroleptic exposure (see table below). Idiopathic PD characteristically starts on one side of the body (with no predilection for either side), and it remains more severe on that side throughout the course. Misdiagnosis is common, and definitive diagnosis is only possible at autopsy.

Generic	(Trade Name)
Acetophenazine	(Tindal®)
Amoxapine	(Asendin®)
Chlorpromazine	(Thorazine®)
Fluphenazine	(Permitil®, Prolixin®)
Haloperidol	(Haldol®)
Loxapine	(Loxitane®, Daxolin®)
Mesoridazine	(Serentil®)
Metaclopramide	(Reglan®)
Molindone	(Lindone®, Moban®)
Perphenazine	(Trilafon® or Triavil®)
Piperacetazine	(Quide®)
Prochlorperazine	(Compazine®, Combid®)
Promazine	(Sparine®)
Promethazine	(Phenergan®)
Thiethylperazine	(Torecan®)
Thioridazine	(Mellaril®)
Thiothixene	(Navane®)
Trifluoperazine	(Stelazine®)
Triflupromazine	(Vesprin®)
Trimeprazine	(Temaril®)

In contrast to tremor and bradykinesia, rigidity is less commonly a patient-reported symptom, except as muscle stiffness or arthritis-like complaints. Assessment of rigidity involves passive movement of the neck, upper limbs, and lower limbs, to assess for an increase in resistance throughout the range of motion.

Postural instability is also a clinical hallmark of PD, but typically emerges later in the course of the disease. Instability is tested with the "pull test," during which the examiner stands behind the patient and asks the patient to maintain their balance when pulled backwards. The examiner pulls back briskly to assess the patient's ability to recover, being careful to prevent the patient from falling.

As PD progresses, abnormal gait (e.g., feet shuffling) accompanies postural instability. It is highly unusual for idiopathic PD patients to have severe gait and postural abnormalities in the first five years of symptoms.

Other signs and symptoms of PD include:

Signs and Symptoms of Parkinson's Disease

Motor	Sensory	Cognitive	Autonomic
Slowness	Numbness	Mood changes	Hot/Cold sensation
Tremor	Aching	Depression	Bladder problems
Stiffness	Restlessness	Anxiety	Sweating
Postural instability	Pain	Panic attacks	Abdominal discomfort
Stooped, shuffling gait	Chest discomfort	Tiredness	Constipation
Decreased arm swing when walking	Anosmia	Confusion	Sialorrhea
Lower extr. cramps		Slowed thinking	Urinary frequency/urgency
Weakness			Erectile Dysfunction
Hypophonia
Swallowing difficulty
Reduced dexterity
Freezing
Masked facies
Micrographia