Diagnosing Parkinson's disease

• 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)
  
  

Reference:

• (1) NICE (July 2017). Parkinson's disease in adults
• (2) Parkinson's disease society. The professional's guide to Parkinson's disease