P1.151 Differential diagnoses of 1528 patients with parkinsonism followed in a tertiary movement disorders clinic

The clinical diagnosis of Parkinson's disease

“…The hypernym term parkinsonism refers to the concomitant finding of two or more out of four signs: bradykinesia, resting tremor, rigidity, and postural instability, 27 invariably including PD as the most common etiologic diagnosis. The term, however, encompasses expanding and variable subsets of disorders that conform to this criterion, including secondary forms [e.g., infectious, drug-induced (DIP), vascular parkinsonism(VP)], sporadic [“atypical parkinsonism” e.g., MSA, PSP, CBD, Lewy body dementia (LBD), etc.…”

“…At the moment, criteria for diagnosis of PD are based on the finding of a combination of motor symptoms and signs as previously stated in this review. 27 However, multiple lines of evidence unequivocally show that by the time when these features surface to clinical detection, pathological and neurochemical hallmarks of the disease are already established and have been already in progress for a considerable amount of time. 33 As such, the quest for a “pre-motor syndrome” delineating potential non-motor features that, alone or in combination, could have enough specificity to suggest the eventual PD diagnosis is of importance for multiple reasons, including the opportunity to contemplate interventions aimed at slowing or stopping disease progression at the earliest pathological stages, even before nigro-striatal degenerative neuronal damage is severe enough to set off early motor dysfunction.…”

“…However, several additional tests play an important role in its differential diagnosis with other movement disorders, such as essential tremor (ET) and atypical parkinsonism. 27 56 Also, genetic testing may add important tools for counseling regarding inheritance, prognosis, and even treatment choices.…”