Parkinson's disease (PD) should be suspected in people presenting with tremor, stiffness, slowness, balance problems and/or gait disorders (1)
people with suspected PD should be referred quickly and untreated to a specialist with expertise in the differential diagnosis of this condition.
the referral time
for people with suspected mild PD should be no more than 6 weeks
in later disease with more complex problems should be within 2 weeks (2)
the diagnosis of PD should be reviewed regularly and re-considered if atypical clinical features develop
generally the diagnosis is based on history taking and physical examination
the commonly used clinical criteria for the diagnosis of PD are the UK Parkinson's Disease Society (PDS) Brain Bank Criteria
single photon emission computed tomography (SPECT) should be considered for people with tremor where essential tremor cannot be clinically differentiated from parkinsonism
structural MRI should not be used in the differential diagnosis of Parkinson's disease
however structural MRI may be considered for the differential diagnosis of parkinsonian syndromes
acute levodopa and apomorphine challenge tests should not be used in the differential diagnosis of parkinsonian syndromes
Review of diagnosis
review the diagnosis of Parkinson's disease regularly, and reconsider it if atypical clinical features develop. (People diagnosed with Parkinson's disease should be seen at regular intervals of 6-12 months to review their diagnosis) (1)
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