Diagnostic Criteria

Key Facts

To diagnose PD you should make sure that parkinsonism is present, that there are no other features suggesting a different condition, and that parkinsonism improves with dopaminergic medications.
To diagnose parkinsonism you need to establish bradykinesia and at least one of the following: muscular rigidity, tremor, or postural instability.
There are no tests to diagnose PD.
The diagnosis of PD should be reviewed regularly and reconsidered if atypical clinical features develop.
Evidence shows that the way a diagnosis of PD is communicated affects how patient-reported outcomes long after.

Clinical Best Practices

People with suspected PD should be referred to a neurologist or movement disorder specialist to confirm diagnosis.
DaTSCAN should not be ordered in place of referral to a neurologist.
It is important to consider caregivers in communicating a diagnosis of PD.
Discussion should balance provision of honest, realistic information and promotion of a feeling of optimism.

Diagnosis of PD should be based on clinical findings. The most widely accepted clinical criteria for the diagnosis of PD are those introduced by the UK PDS Brain Bank Diagnostic Criteria.

Table of Contents

Diagnosis of Parkinsonism
Exclusion Criteria for PD
Features that Support a Diagnosis of PD

Diagnosis of Parkinsonism

Bradykinesia and at least one of the following:

Muscular rigidity
4–6 Hz resting tremor
Postural instability not caused by primary visual, vestibular, cerebellar, or proprioceptive dysfunction

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Exclusion Criteria for PD

History of the following:

Repeated strokes with stepwise progression
Repeated head injury
Antipsychotic or dopamine-depleting drugs
Definite encephalitis and/or oculogyric crisesⁱ on no drug treatment
More than 1 affected relative
Sustained remission
Negative response to large doses of levodopa (up to 1,000-1,500 mg/day if tolerated), if malabsorption is excluded
Strictly unilateral features after 3 years
Other neurological features: supranuclear gaze palsy, cerebellar signs, early severe autonomic involvement, Babinski sign, early severe dementia with disturbances of language, memory, or praxis
Exposure to known neurotoxin
Presence of cerebral tumor or communicating hydrocephalus on neuroimaging