Differential diagnosis of parkinsonism with visual inspection of posture and gait in the early stage

Abstract

Background: Parkinson's disease (PD) differs from atypical parkinsonism in many clinical aspects. Principally, posture and gait are distinct features in the early stages of the disease; thus, these differences can be helpful in differential diagnosis. Methods: We analyzed videos of patients with PD or atypical parkinsonism. A total of 76 patients with early PD (n = 56) or atypical parkinsonism (n = 20) were included. Items related to posture and gait were classified into three categories (standing, gait and associated symptoms) and each sub-item was analyzed. Results: Asymmetric arm-swing (p = 0.004) and accompanying tremor (p = 0.016) were significant indicators of early-stage PD. Staggering gait (p = 0.007) and en-bloc turning (p = 0.026) were more common in atypical parkinsonism. Characteristics with a high odds-ratio for atypical parkinsonism were en-bloc turning (beta = 8.475, p = 0.032) and normal arm-swing (beta = 14.6084, p = 0.036). Conclusions: Visual inspection of gait and posture provides reliable clues in the differential diagnosis of parkinsonism.