From the Guidelines
A new Parkinson's disease work-up should begin with a comprehensive neurological examination, focusing on cardinal motor symptoms, and initial imaging should include an MRI of the brain to exclude structural lesions, as recommended by the American College of Radiology 1. The initial steps for a new Parkinson's disease (PD) workup involve a thorough evaluation to confirm the diagnosis and rule out other conditions that may present with similar symptoms.
- Key components of the initial workup include:
- A comprehensive neurological examination to assess for cardinal motor symptoms such as resting tremor, bradykinesia, rigidity, and postural instability
- Laboratory tests to rule out other conditions, including CBC, metabolic panel, thyroid function, vitamin B12, and ceruloplasmin (to rule out Wilson's disease)
- Initial imaging with an MRI of the brain to exclude structural lesions, as recommended by the American College of Radiology 1
- Additional diagnostic tools that may be ordered include a DaTscan (dopamine transporter scan) to help differentiate Parkinson's from essential tremor or drug-induced parkinsonism.
- Non-motor symptoms should also be assessed, including depression, cognitive changes, sleep disorders, and autonomic dysfunction.
- Early referral to a movement disorder specialist is beneficial for confirming diagnosis and optimizing treatment, as Parkinson's is primarily a clinical diagnosis, and proper assessment helps distinguish it from Parkinson-plus syndromes and other movement disorders that may require different management approaches 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Initial Steps for a New Parkinson's Disease (PD) Workup
The initial steps for a new Parkinson's disease (PD) workup involve a comprehensive evaluation of the patient's history and examination. The following are key components of this evaluation:
- History: includes prodromal features (eg, rapid eye movement sleep behavior disorder, hyposmia, constipation), characteristic movement difficulty (eg, tremor, stiffness, slowness), and psychological or cognitive problems (eg, cognitive decline, depression, anxiety) 2
- Examination: typically demonstrates bradykinesia with tremor, rigidity, or both 2
- Diagnostic tests: Dopamine transporter single-photon emission computed tomography can improve the accuracy of diagnosis when the presence of parkinsonism is uncertain 2
Disease Variants and Prognosis
PD has multiple disease variants with different prognoses, including:
- Diffuse malignant subtype (9%-16% of individuals with PD): prominent early motor and nonmotor symptoms, poor response to medication, and faster disease progression 2
- Mild motor-predominant PD (49%-53% of individuals with PD): mild symptoms, good response to dopaminergic medications, and slower disease progression 2
- Intermediate subtype: characteristics and prognosis vary 2
Treatment Approaches
Treatment for PD is symptomatic, focused on improvement in motor and nonmotor signs and symptoms. Approaches include:
- Pharmacologic treatments: dopamine-based therapies, monoamine oxidase B inhibitors, and other medications 2, 3, 4, 5, 6
- Nonpharmacologic approaches: exercise, physical, occupational, and speech therapies, and deep brain stimulation 2
- Rehabilitative therapy: complements pharmacologic treatments and helps improve motor function and quality of life 2