Practice Parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review) [RETIRED]

Abstract

Abstract-Objective:To define key issues in the diagnosis of Parkinson disease (PD), to define features influencing progression, and to make evidence-based recommendations. Two clinical questions were identified: 1) Which clinical features and diagnostic modalities distinguish PD from other parkinsonian syndromes? 2) Which clinical features predict rate of disease progression? Methods: Systematic review of the literature was completed. Articles were classified according to a four-tiered level of evidence scheme. Recommendations were based on the evidence. Results and Conclusions: 1. Early falls, poor response to levodopa, symmetry of motor manifestations, lack of tremor, and early autonomic dysfunction are probably useful in distinguishing other parkinsonian syndromes from Parkinson disease (PD). 2. Levodopa or apomorphine challenge and olfactory testing are probably useful in distinguishing PD from other parkinsonian syndromes. 3. Predictive factors for more rapid motor progression, nursing home placement, and shorter survival time include older age at onset of PD, associated comorbidities, presentation with rigidity and bradykinesia, and decreased dopamine responsiveness. Future research into methods for earlier and more accurate diagnosis of the disease and identification and clarification of predictive factors of rapid disease progression is warranted. NEUROLOGY 2006;66:968-975

The Neuroprotective Effect of Dimethyl Fumarate in an MPTP-Mouse Model of Parkinson's Disease: Involvement of Reactive Oxygen Species/Nuclear Factor-κB/Nuclear Transcription Factor Related to NF-E2

“…Recent years have witnessed an increase of therapies for the treatment of PD, including pharmacotherapy, nonpharmacological alternative approaches, and innovative surgical interventions (1,7). Despite these breakthroughs, effective disease-modifying therapy for PD has not yet been approved (41,64). Modification of the disease course by neuroprotective therapy is an important unmet clinical need; toward this end, understanding the cellular mechanisms involvement in PD is the subject of intensive research (26).…”

Odor detection threshold, but not odor identification, is impaired in children with autism

“…Impaired olfaction has been found to be most strongly associated with Parkinson"s disease (PD), and it seems to be a biomarker of the disease. Olfactory testing has already become a recommended part of the diagnostic process with regard to its potential for distinguishing PD from other parkinsonian syndromes [4].…”

Diagnostic Accuracy of Combined FP-CIT, IBZM, and MIBG Scintigraphy in the Differential Diagnosis of Degenerative Parkinsonism: A Multidimensional Statistical Approach

“…This procedure allows differentiation of degenerative parkinsonism from movement disorders that are not associated with dopaminergic deficit, such as essential tremor (4,5,10). DAT imaging alone, however, does not differentiate the various types of degenerative parkinsonism (PD vs. APD) with sufficient accuracy (5,11).…”