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Symptoms
• Tremor at rest – usually worse on one side of the body, pill-rolling tremor
• Bradykinesia – slowness of movement, delay in initiating movements
• Postural Instability – can lead to frequent falling
• Rigidity – increased tone or stiffness of the muscles (“cogwheel rigidity”), when it occurs in the face, it can cause the classic “mask-like” appearance associated with PD
• Hypokinesia – slow movements
• Flexed posture
• Loss of postural reflexes – normal arm swing is lacking, steps are short and shuffling (festination), there is difficulty in negotiating turns
• Freezing phenomenon (“akinesia”)
• Depression
• Sleep disturbances
• Dizziness
• Stooped posture
• Micrographia (progressively smaller handwriting)
• Constipation
• Dementia
• Speech problems
• Swallowing problems
• Sexual dysfunction
Several other conditions can mimic the neurologic symptoms of PD and must be excluded before
the diagnosis is established. It is important to differentiate between true idiopathic Parkinson’s
Disease and parkinsonian symptoms that develop secondary to some underlying condition or
medication.
• Medications (see below)
• Carbon monoxide
• Alcohol withdrawal
• MPTP (a synthetic heroin)
• Multi-infarct disease (multiple small strokes)
• Parathyroid or thyroid abnormalities
• Brain tumors
• Hydrocephalus
• Alzheimer’s Disease
• Wilson’s Disease
• Anxiety
• Antipsychotics (e.g., haloperidol, thioridazine, risperidone, lithium, chlorpromazine)
• Antiemetics (to treat nausea and vomiting) e.g., prochlorperazine, metoclopramide
• Antihypertensives (blood pressure drugs) e.g., methyldopa, verapamil, captopril, reserpine
• Antianginals (heart medications to treat angina or chest pain) e.g., diltiazem
• Antineoplastics (cancer chemotherapy drugs) e.g., cytarabine, vincristine
• Antiepileptics (anti-seizure medications) e.g., valproate, phenytoin
Currently, there are no blood or imaging tests to accurately diagnose PD, therefore the diagnosis
is made predominantly through evaluation of symptoms. Unfortunately, PD is misdiagnosed by
neurologists in 25-35% of cases. These numbers improve when the diagnosis is made by a
specialist in PD and other movement disorders.
• Complete Blood Count (CBC)
• Blood chemistries
• Liver function tests
• Thyroid function tests
• Drug/Toxicology screen (if appropriate)
• 24-hour urine copper excretion (if Wilson’s disease is suspected)
• Liver biopsy (if Wilson’s disease is suspected)
These studies may be used to exclude conditions that may mimic the neurologic symptoms of
PD:
• Computed Tomography (CT) of the head
• Magnetic Resonance Imaging (MRI) of the brain
• Single Photon Emission Computed Tomography (SPECT)
Copyright 2001. MediFocus Guide from Medifocus.com, Inc. www.medifocus.com (800) 965-3002
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