Part of parkinsonian patients develops, over time, subcortical dementia.
Although the diagnosis of Parkinson’s disease is largely clinical, can take account of hyposmia (may precede up to 20 years to your appearance), positron emission tomography showing decrease of dopamine in the striatum, markers recently biological and electromyography to show subclinical tremor.
An important chapter of this issue is that of drug-induced parkinsonism, which generally refers to the interruption but not always. Drugs that can induce are neuroleptics (phenothiazines, butyrophenones), depleting dopamine (reserpine, tetrabenazine) and calcium channel blockers (cinnarizine, flunarizine).
The clinician, before diagnosing Parkinson’s disease, should take into account the possibility cited in the preceding paragraph as well as a number of neurological disorders that are targets of specialized study.
Fustinoni (in Semiology Nervous System [1997]) says the following signs and symptoms exclude the diagnosis of Parkinson’s disease:
Signs and Symptoms that exclude Parkinson
l buccolingual dyskinesia (parkinsonism drug)
l hyperreflexia not justified by previous stroke (Vascular parkinsonism)
l pseudobulbar syndrome (vascular parkinsonism)
l or intentional tremor predominant attitude (Essential tremor)
