Diagnosis of Parkinson’s disease

The diagnosis of Parkinson’s disease can be straightforward if the disease has progressed for many years when the slowness, the stiffness, the walking difficulties and the tremor at rest are typical of the condition.
Unfortunately, the diagnosis of Parkinson’s disease can be difficult at the beginning of the condition, where the signs of the disease are very mild. The clinical examination should look actively for characteristic features such as a handwriting become smaller at the end of a sentence, a decrease arm swing when walking, a hand tremor when performing mental arithmetic, a stiffness of a wrist when performing a motor task with the other hand. The diagnosis can be supported by a recent loss of the sense of smell or vivid dreams at night.

Parkinson-Plus: what are they?

They are conditions which can look initially like Parkinson’s disease as they share parkinsonian features such as slowness, stiffness, walking difficulties, speech difficulties. The word “Plus” means that there are additional features in addition to the parkinsonian clinical pictures.
Their names are as follow:

  • Progressive supranuclear palsy (PSP)
  • Cortico-basal degeneration (CBD)
  • Frontotemporal dementia (FTD)
  • Multiple system atrophy (MSA)
  • Lewy body dementia (LBD).

The diagnosis is suggested when the parkinsonian features are obvious but associated with other symptoms or signs which are not expected in Parkinson’s disease. These red flags can be an unsteadiness as early symptoms, a staring gaze, a too upright posture or a too tilted trunk, a clumsy or a jerky hand, a stuttering speech, a drop of blood pressure when standing up, some visual hallucinations without taking any drug treatment, etc. The recognition of these red flags can be difficult for a nonspecialist doctor but is important to consider as they lead to the diagnosis of Parkinson-Plus, which though it mimics Parkinson’s disease it does not share the same prognosis.

The prognosis is more severe, as these conditions don’t respond as well to Levodopa, and the patients are more disabled due to the extension of the disease process in the brain.

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