Clinical Aspects of the Differential Diagnosis of Parkinson’s Disease and Parkinsonism

Abstract

Parkinsonism is a clinical syndrome presenting with bradykinesia, tremor, rigidity, and pos tural instability. Nonmotor symptoms have recently been included in the parkinsonian syn drome, which was traditionally associated with motor symptoms only. Various pathologically distinct and unrelated diseases have the same clinical manifestations as parkinsonism or par kinsonian syndrome. The etiologies of parkinsonism are classified as neurodegenerative dis eases related to the accumulation of toxic protein molecules or diseases that are not neurode generative. The former class includes Parkinson’s disease (PD), multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration. Over the past decade, clinical diagnostic criteria have been validated and updated to improve the accuracy of diagnosing these diseases. The latter class of disorders unrelated to neurodegenerative diseases are classi fied as secondary parkinsonism, and include drug-induced parkinsonism (DIP), vascular parkinsonism, and idiopathic normal-pressure hydrocephalus (iNPH). DIP and iNPH are regarded as reversible and treatable forms of parkinsonism. However, studies have suggested that the absence of protein accumulation in the nervous system as well as managing the un derlying causes do not guarantee recovery. Here we review the differential diagnosis of PD and parkinsonism, mainly focusing on the clinical aspects. In addition, we describe recent updates to the clinical criteria of various disorders sharing clinical symptoms with parkinsonism.