Fortnightly Review: Parkinsonism--recognition and differential diagnosis

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Abstract
Summary points The cumulative lifetime risk of a person developing parkinsonism has been estimated at 1 in 40Idiopathic Parkinson's disease is the commonest cause, but about a third of patients with the syndrome of parkinsonism or a diagnosis of Parkinson's disease have some other disease insteadThe diagnosis of Parkinson's disease is entirely clinical, but the results of certain investigations may help in recognising alternative causes for parkinsonismFor a diagnosis of established parkinsonism, upper body akinesia must be present; rigidity is usually, but not always, present; tremor is an optional extraThe two conditions that are most commonly misdiagnosed as Parkinson's disease—essential tremor and arteriosclerotic pseudoparkinsonism—do not display true parkinsonism Summary points The cumulative lifetime risk of a person developing parkinsonism has been estimated at 1 in 40Idiopathic Parkinson's disease is the commonest cause, but about a third of patients with the syndrome of parkinsonism or a diagnosis of Parkinson's disease have some other disease insteadThe diagnosis of Parkinson's disease is entirely clinical, but the results of certain investigations may help in recognising alternative causes for parkinsonismFor a diagnosis of established parkinsonism, upper body akinesia must be present; rigidity is usually, but not always, present; tremor is an optional extraThe two conditions that are most commonly misdiagnosed as Parkinson's disease—essential tremor and arteriosclerotic pseudoparkinsonism—do not display true parkinsonism