PDF herunterladen
Semin Neurol 2007; 27(2): 113-122
DOI: 10.1055/s-2007-971174
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Parkinsonism: A Review-of-Systems Approach to Diagnosis

Paul J. Tuite1 , Kimberly Krawczewski1
  • 1Department of Neurology, University of Minnesota, Minneapolis, Minnesota
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
27. März 2007 (online)

    Lizenzen und Reprints

ABSTRACT

Atypical parkinsonian disorders may be initially misdiagnosed as Parkinson's disease. The number and complexity of atypical parkinsonisms seem to be increasing. This, along with the lack of diagnostic tests, makes it difficult for the clinician to distinguish between disease types. It then becomes necessary to assess patients in multiple areas through a review-of-systems approach. An approach of this kind can be used for initial diagnosis, monitoring, refinement of diagnosis, and disease management. This article discusses some of the clinical features for a review-of-systems assessment. Using this approach may allow earlier detection of atypical parkinsonisms, leading to better management of symptoms.

KEYWORDS

Parkinson's disease - atypical parkinsonisms - progressive supranuclear palsy - dementia with Lewy bodies - multiple system atrophy - corticobasal degeneration - vascular parkinsonism - medication-induced parkinsonism - normal pressure hydrocephalus

REFERENCES

  • 1 Rajput A H, Rozdilsky B, Rajput A. Accuracy of clinical diagnosis in parkinsonism: a prospective study.  Can J Neurol Sci. 1991;  18 275-278
    PubMedGoogle Scholar
  • 2 Hughes A J, Colosimo C, Kleedorfer B, Daniel S E, Lees A J. The dopaminergic response in multiple system atrophy.  J Neurol Neurosurg Psychiatry. 1992;  55 1009-1013
    CrossrefPubMedGoogle Scholar
  • 3 Hughes A J, Daniel S E, Lees A J. Improved accuracy of clinical diagnosis of Lewy body Parkinson's disease.  Neurology. 2001;  57 1497-1499
    PubMedGoogle Scholar
  • 4 Gelb D J, Oliver E, Gilman S. Diagnostic criteria for Parkinson disease.  Arch Neurol. 1999;  56 33-39
    CrossrefPubMedGoogle Scholar
  • 5 Wenning G K, Ben-Shlomo Y, Hughes A, Daniel S E, Lees A, Quinn N P. What clinical features are most useful to distinguish definite multiple system atrophy from Parkinson's disease?.  J Neurol Neurosurg Psychiatry. 2000;  68 434-440
    CrossrefPubMedGoogle Scholar
  • 6 Jankovic J, Rajput A H, McDermott M P, Perl D P. The evolution of diagnosis in early Parkinson disease.  Arch Neurol. 2000;  57 369-372
    CrossrefPubMedGoogle Scholar
  • 7 Pal P K, Samii A, Calne D B. Cardinal features of early Parkinson's disease. In: Factor SA, Weiner WJ Parkinson's Disease Diagnosis and Clinical Management. Vol. 1. 1st ed. New York; Demos 2002: 41-56
    Google Scholar
  • 8 Watanabe T, Akiguchi I, Yagi H et al.. Proton magnetic resonance spectroscopy and white matter hyperintensities on magnetic resonance imaging in patients with Alzheimer's disease.  Ann NY Acad Sci. 2002;  977 423-429
    PubMedGoogle Scholar
  • 9 Quinn N P. How to diagnose multiple system atrophy.  Mov Disord. 2005;  20(suppl 12) S5-S10
    CrossrefPubMedGoogle Scholar
  • 10 Greco C M, Berman R F, Martin R M et al.. Neuropathology of fragile X-associated tremor/ataxia syndrome (FXTAS).  Brain. 2006;  129 243-255
    PubMedGoogle Scholar
  • 11 Verghese J, Lipton R B, Dickson D W, Crystal H J. A clinicopathological study of rest tremors in the elderly.  J Am Geriatr Soc. 2004;  52 1781-1783
    CrossrefPubMedGoogle Scholar
  • 12 Meara J, Bhowmick B K, Hobson P. Accuracy of diagnosis in patients with presumed Parkinson's disease.  Age Ageing. 1999;  28 99-102
    CrossrefPubMedGoogle Scholar
  • 13 Bower J H, Maraganore D M, McDonnell S K, Rocca W A. Incidence and distribution of parkinsonism in Olmsted County, Minnesota, 1976-1990.  Neurology. 1999;  52 1214-1220
    CrossrefPubMedGoogle Scholar
  • 14 Colosimo C. Pisa syndrome in a patient with multiple system atrophy.  Mov Disord. 1998;  13 607-609
    CrossrefPubMedGoogle Scholar
  • 15 Colosimo C, Albanese A, Hughes A J, de Bruin V M, Lees A J. Some specific clinical features differentiate multiple system atrophy (striatonigral variety) from Parkinson's disease.  Arch Neurol. 1995;  52 294-298
    PubMedGoogle Scholar
  • 16 Louis E D, Schupf N, Manly J, Marder K, Tang M X, Mayeux R. Association between mild parkinsonian signs and mild cognitive impairment in a community.  Neurology. 2005;  64 1157-1161
    PubMedGoogle Scholar
  • 17 Wenning G K, Ben Shlomo Y, Magalhaes M, Daniel S E, Quinn N P. Clinical features and natural history of multiple system atrophy: an analysis of 100 cases.  Brain. 1994;  117 835-845
    CrossrefPubMedGoogle Scholar
  • 18 Clarke C E, Davies P. Systematic review of acute levodopa and apomorphine challenge tests in the diagnosis of idiopathic Parkinson's disease.  J Neurol Neurosurg Psychiatry. 2000;  69 590-594
    CrossrefPubMedGoogle Scholar
  • 19 Nutt J G, Wooten G F. Clinical practice: diagnosis and initial management of Parkinson's disease.  N Engl J Med. 2005;  353 1021-1027
    CrossrefPubMedGoogle Scholar
  • 20 Stolze H, Kuhtz-Buschbeck J P, Drucke H, Johnk K, Illert M, Deuschl G. Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson's disease.  J Neurol Neurosurg Psychiatry. 2001;  70 289-297
    CrossrefPubMedGoogle Scholar
  • 21 Curran T, Lang A E. Parkinsonian syndromes associated with hydrocephalus: case reports, a review of the literature, and pathophysiological hypotheses.  Mov Disord. 1994;  9 508-520
    CrossrefPubMedGoogle Scholar
  • 22 Hebb A O, Cusimano M D. Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome.  Neurosurgery. 2001;  49 1166-1184 discussion 1184-1186
    PubMedGoogle Scholar
  • 23 McGirt M J, Woodworth G, Coon A L, Thomas G, Williams M A, Rigamonti D. Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus.  Neurosurgery. 2005;  57 699-705 discussion 699-705
    PubMedGoogle Scholar
  • 24 Demirkiran M, Bozdemir H, Sarica Y. Vascular parkinsonism: a distinct, heterogeneous clinical entity.  Acta Neurol Scand. 2001;  104 63-67
    CrossrefPubMedGoogle Scholar
  • 25 Bower J H, Dickson D W, Taylor L, Maraganore D M, Rocca W A. Clinical correlates of the pathology underlying parkinsonism: a population perspective.  Mov Disord. 2002;  17 910-916
    CrossrefPubMedGoogle Scholar
  • 26 Zijlmans J C, Daniel S E, Hughes A J, Revesz T, Lees A J. Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis.  Mov Disord. 2004;  19 630-640
    CrossrefPubMedGoogle Scholar
  • 27 Factor S A, Jennings D L, Molho E S, Marek K L. The natural history of the syndrome of primary progressive freezing gait.  Arch Neurol. 2002;  59 1778-1783
    CrossrefPubMedGoogle Scholar
  • 28 Schneider J A, Li J L, Li Y, Wilson R S, Kordower J H, Bennett D A. Substantia nigra tangles are related to gait impairment in older persons.  Ann Neurol. 2006;  59 166-173
    CrossrefPubMedGoogle Scholar
  • 29 Giladi N, Herman T, Reider-Groswasser I I, Gurevich T, Hausdorff J M. Clinical characteristics of elderly patients with a cautious gait of unknown origin.  J Neurol. 2005;  252 300-306
    PubMedGoogle Scholar
  • 30 Hohl U, Tiraboschi P, Hansen L A, Thal L J, Corey-Bloom J. Diagnostic accuracy of dementia with Lewy bodies.  Arch Neurol. 2000;  57 347-351
    CrossrefPubMedGoogle Scholar
  • 31 Boesch S M, Wenning G K, Ransmayr G, Poewe W. Dystonia in multiple system atrophy.  J Neurol Neurosurg Psychiatry. 2002;  72 300-303
    CrossrefPubMedGoogle Scholar
  • 32 Wenning G K, Geser F, Stampfer-Kountchev M, Tison F. Multiple system atrophy: an update.  Mov Disord. 2003;  18(suppl 6) S34-S42
    CrossrefPubMedGoogle Scholar
  • 33 Shiba M, Bower J H, Maraganore D M et al.. Anxiety disorders and depressive disorders preceding Parkinson's disease: a case-control study.  Mov Disord. 2000;  15 669-677
    CrossrefPubMedGoogle Scholar
  • 34 Lange K W, Tucha O, Alders G L et al.. Differentiation of parkinsonian syndromes according to differences in executive functions.  J Neural Transm. 2003;  110 983-995
    CrossrefPubMedGoogle Scholar
  • 35 Ala T A, Hughes L F, Kyrouac G A, Ghobrial M W, Elble R J. Pentagon copying is more impaired in dementia with Lewy bodies than in Alzheimer's disease.  J Neurol Neurosurg Psychiatry. 2001;  70 483-488
    CrossrefPubMedGoogle Scholar
  • 36 Aarsland D, Litvan I, Larsen J P. Neuropsychiatric symptoms of patients with progressive supranuclear palsy and Parkinson's disease.  J Neuropsychiatry Clin Neurosci. 2001;  13 42-49
    PubMedGoogle Scholar
  • 37 Burn D J, Lees A J. Progressive supranuclear palsy: where are we now?.  Lancet Neurol. 2002;  1 359-369
    CrossrefPubMedGoogle Scholar
  • 38 Kuniyoshi S, Riley D E, Zee D S, Reich S G, Whitney C, Leigh R J. Distinguishing progressive supranuclear palsy from other forms of Parkinson's disease: evaluation of new signs.  Ann NY Acad Sci. 2002;  956 484-486
    PubMedGoogle Scholar
  • 39 Boeve B F, Lang A E, Litvan I. Corticobasal degeneration and its relationship to progressive supranuclear palsy and frontotemporal dementia.  Ann Neurol. 2003;  54(suppl 5) S15-S19
    CrossrefPubMedGoogle Scholar
  • 40 Pharr V, Uttl B, Stark M, Litvan I, Fantie B, Grafman J. Comparison of apraxia in corticobasal degeneration and progressive supranuclear palsy.  Neurology. 2001;  56 957-963
    CrossrefPubMedGoogle Scholar
  • 41 Quinn N P. Parkinson's disease dyskinesias.  Neurology. 1994;  44 1187 author reply 1187-1188
    PubMedGoogle Scholar
  • 42 Vidailhet M, Rivaud S, Gouider-Khouja N et al.. Eye movements in parkinsonian syndromes.  Ann Neurol. 1994;  35 420-426
    CrossrefPubMedGoogle Scholar
  • 43 Rivaud-Pechoux S, Vidailhet M, Gallouedec G, Litvan I, Gaymard B, Pierrot-Deseilligny C. Longitudinal ocular motor study in corticobasal degeneration and progressive supranuclear palsy.  Neurology. 2000;  54 1029-1032
    PubMedGoogle Scholar
  • 44 Mosimann U P, Muri R M, Burn D J, Felblinger J, O'Brien J T, McKeith I G. Saccadic eye movement changes in Parkinson's disease dementia and dementia with Lewy bodies.  Brain. 2005;  128 1267-1276
    CrossrefPubMedGoogle Scholar
  • 45 Scaravilli T, Tolosa E, Ferrer I. Progressive supranuclear palsy and corticobasal degeneration: lumping versus splitting.  Mov Disord. 2005;  20(suppl 12) S21-S28
    CrossrefPubMedGoogle Scholar
  • 46 Muller A, Reichmann H, Livermore A, Hummel T. Olfactory function in idiopathic Parkinson's disease (IPD): results from cross-sectional studies in IPD patients and long-term follow-up of de-novo IPD patients.  J Neural Transm. 2002;  109 805-811
    CrossrefPubMedGoogle Scholar
  • 47 Katzenschlager R, Zijlmans J, Evans A, Watt H, Lees A J. Olfactory function distinguishes vascular parkinsonism from Parkinson's disease.  J Neurol Neurosurg Psychiatry. 2004;  75 1749-1752
    CrossrefPubMedGoogle Scholar
  • 48 Kluin K J, Foster N L, Berent S, Gilman S. Perceptual analysis of speech disorders in progressive supranuclear palsy.  Neurology. 1993;  43 563-566
    CrossrefPubMedGoogle Scholar
  • 49 Vodusek D B. Sphincter EMG and differential diagnosis of multiple system atrophy.  Mov Disord. 2001;  16 600-607
    CrossrefPubMedGoogle Scholar
  • 50 Brooks D J. Safety and tolerability of COMT inhibitors.  Neurology. 2004;  62 S39-S46
    CrossrefPubMedGoogle Scholar
  • 51 Boeve B F, Silber M H, Ferman T J, Lucas J A, Parisi J E. Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy.  Mov Disord. 2001;  16 622-630
    CrossrefPubMedGoogle Scholar
  • 52 Sakakibara R, Hattori T, Uchiyama T, Yamanishi T. Videourodynamic and sphincter motor unit potential analyses in Parkinson's disease and multiple system atrophy.  J Neurol Neurosurg Psychiatry. 2001;  71 600-606
    Google Scholar
  • 53 Druschky A, Hilz M J, Platsch G et al.. Differentiation of Parkinson's disease and multiple system atrophy in early disease stages by means of I-123-MIBG-SPECT.  J Neurol Sci. 2000;  175 3-12
    CrossrefPubMedGoogle Scholar
  • 54 Goldstein D S. Dysautonomia in Parkinson's disease: neurocardiological abnormalities.  Lancet Neurol. 2003;  2 669-676
    CrossrefPubMedGoogle Scholar
  • 55 Gilman S, Low P A, Quinn N et al.. Consensus statement on the diagnosis of multiple system atrophy.  J Neurol Sci. 1999;  163 94-98
    CrossrefPubMedGoogle Scholar
  • 56 Kitae S, Murata Y, Tachiki N, Okazaki M, Harada T, Nakamura S. Assessment of cardiovascular autonomic dysfunction in multiple system atrophy.  Clin Auton Res. 2001;  11 39-44
    CrossrefPubMedGoogle Scholar
  • 57 Holmberg B, Kallio M, Johnels B, Elam M. Cardiovascular reflex testing contributes to clinical evaluation and differential diagnosis of parkinsonian syndromes.  Mov Disord. 2001;  16 217-225
    CrossrefPubMedGoogle Scholar
  • 58 Wenning G K, Scherfler C, Granata R et al.. Time course of symptomatic orthostatic hypotension and urinary incontinence in patients with postmortem confirmed parkinsonian syndromes: a clinicopathological study.  J Neurol Neurosurg Psychiatry. 1999;  67 620-623
    CrossrefPubMedGoogle Scholar
  • 59 Gelb D J, Oliver E, Gilman S. Diagnostic criteria for Parkinson disease.  Arch Neurol. 1999;  56 33-39
    CrossrefPubMedGoogle Scholar
  • 60 Steele J C, Richardson J C, Olszewski J. Progressive supranuclear palsy: a heterogeneous degeneration involving the brain stem, basal ganglia and cerebellum with vertical gaze and pseudobulbar palsy, nuchal dystonia and dementia.  Arch Neurol. 1964;  10 333-359
    CrossrefPubMedGoogle Scholar
  • 61 Litvan I, Agid Y, Calne D et al.. Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop.  Neurology. 1996;  47 1-9
    CrossrefPubMedGoogle Scholar
  • 62 McKeith I G, Dickson D W, Lowe J et al.. Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium.  Neurology. 2005;  65 1863-1872
    CrossrefPubMedGoogle Scholar

Paul J TuiteM.D. 

Associate Professor, Department of Neurology, University of Minnesota, MMC 295

420 Delaware Street SE, Minneapolis, MN 55455

      >