Objective: This study aims to identify the main symptoms associated with the clinical diagnosis of parkinsonism, excluding Parkinson’s disease (PD), among patients evaluated by non-specialist physicians in movement disorders.

Background: The accurate diagnosis of Parkinson’s disease (PD) and other parkinsonian syndromes is crucial for treatment and prognosis, but also for epidemiological, clinical, and pharmacological research. PD, due to its reliance on clinical symptoms and high prevalence, often is overdiagnosed, while other parkinsonisms are frequently underdiagnosed, especially in early stages. PD can be confused with essential tremor, progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, Lewy body dementia, and functional parkinsonism.

Method: A descriptive analysis was conducted on patients initially diagnosed with PD who visited the primary investigator, a neurologist specializing in movement disorders.  Participants completed a questionnaire pertaining to signs and symptoms indicative of parkinsonism, including uncontrolled movements, hypophonia, drooling, weakness, paresthesias, rigidity, tremor, micrographia, pain, apraxia, reduced arm swing, postural instability, stooped posture, hyposmia, altered rapid eye movement (REM) sleep, cognitive problems, bradykinesia, hypomimia, difficulty walking, and depression. The symptoms that are most frequently present or absent in patients with other types of parkinsonism were identified.

Results: In the study of 10 patients, predominantly male (60%), the average age of symptom onset was 62 years, with tremor being the main initial symptom (60%). Patients with other forms of parkinsonism commonly showed weakness (80%), hypoesthesia (50%), and postural instability (100%). Unlike those with PD, they less frequently exhibited reduced arm swing (60%), altered REM sleep (20%), and hyposmia (10%).

Conclusion: The underdiagnosis of parkinsonian syndromes besides PD is common, highlighting the importance of recognizing symptoms that suggest alternative diagnosis. Key symptoms like weakness, hypoesthesia, and postural instability, and with the absence of reduced arm swing, sleep disturbances, and hyposmia, deserve special attention in differentiating diagnoses. These initial findings are part of an ongoing research that will compare symptoms between PD patients and those with other parkinsonian syndromes.

General characteristics

Clinical manifestations

References: 1. Braak H, Del Tredici K, Rüb U, De Vos RAI, Jansen Steur ENH, Braak E. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging. 2003 Mar 1;24(2):197–211.
2. Rajput AH, Rozdilsky B, Rajput A. Accuracy of Clinical Diagnosis in Parkinsonism — A Prospective Study. Can J Neurol Sci. 1991;18(3):275–8.
3. Hustad E, Skogholt AH, Hveem K, Aasly JO. The accuracy of the clinical diagnosis of Parkinson disease. The HUNT study. J Neurol 2018 2659 [Internet]. 2018 Jul 10 [cited 2021 Aug 29];265(9):2120–4. Available from: https://link.springer.com/article/10.1007/s00415-018-8969-6

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MDS Abstracts - https://www.mdsabstracts.org/abstract/identifying-key-symptoms-associated-to-parkinsonism-other-than-parkinsons-disease-a-case-series/