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Review
. 2006 Jul;52(7):862-8.

Approach to diagnosis of Parkinson disease

Christopher Frank  1 , Giovanna Pari, John P Rossiter
Affiliations
Review

Approach to diagnosis of Parkinson disease

Christopher Frank et al. Can Fam Physician. 2006 Jul.

Abstract
in English, French

Objective: To review the clinical features of Parkinson disease (PD) and other causes of motor parkinsonism with an emphasis on diagnosis in elderly patients. SOURCES OF INFORMATION MEDLINE: and Google Scholar were searched for original research articles describing clinical diagnosis of parkinsonism. Consensus statements and articles summarizing diagnostic criteria for parkinsonian syndromes were also reviewed. Most evidence was levels II or III.

Main message: Diagnosis of PD is made clinically and can be challenging. In older patients, PD can present with general functional decline and nonspecific symptoms. Clinical criteria for diagnosing PD and the TRAP mnemonic can be helpful. A 2-week trial of levodopa-carbidopa treatment can be considered. Specific signs and a minimal response to levodopa treatment suggest other causes of parkinsonism. Clinical features of other causes of parkinsonism are reviewed in the article.

Conclusion: Parkinsonism and PD are common in older patients. Family physicians should consider parkinsonism in the differential diagnosis of patients who have falls and exhibit general functional decline.

OBJECTIF: Rappeler les caractéristiques cliniques de la maladie de Parkinson (MP) et les autres causes de parkinsonisme moteur, avec une insistance particulière sur le diagnostic chez la personne âgée.

SOURCE DE L’INFORMATION: On a recherché dans MEDLINE et Google Scholar les articles de recherche décrivant le diagnostic clinique du parkinsonisme. On a également révisé des déclarations consensuelles et des articles résumant les critères diagnostiques du syndrome parkinsonien. Les preuves étaient principalement de niveaux II ou III.

PRINCIPAL MESSAGE: Le diagnostic de la MP est d’ordre clinique et il peut s’avérer difficile. Chez le patient âgé, la MP peut s’accompagner d’un déclin fonctionnel global et de symptômes non spécifiques. Les critères cliniques de diagnostic et l’aide mnémotechnique TRAP peuvent être utiles. On peut tenter un traitement de 2 semaines avec la lévodopa-carbidopa. Certains signes spécifiques et une faible réponse à la lévodopa suggèrent d’autres causes de parkinsonisme, lesquels sont passé en revue dans cet article.

CONCLUSION: Le parkinsonisme et la MP sont fréquents chez le patient âgé. Le médecin de famille devrait penser au parkinsonisme lors du diagnostic différentiel des patients qui présentent des chutes et un déclin fonctionnel général.

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Figures

Figure 1
Figure 1. Appearance of the substantia nigra in a normal midbrain and in the midbrain of a patient with Parkinson disease
In the normal midbrain, the substantia nigra is darkly pigmented. In idiopathic Parkinson disease, marked pallor is due to degeneration and loss of dopaminergic neurons. Some of the surviving neurons contain characteristic eosinophilic Lewy body inclusions.
See this image and copyright information in PMC

Comment in

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