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The Diagnosis of Parkinson's Disease

William C. Koller, MD, PhD
Arch Intern Med. 1984;144(11):2146-2147. doi:10.1001/archinte.1984.04400020048005.
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Parkinson's disease is a disorder of middle and late life, with an insidious onset, gradual progression, and a prolonged course. Recognition is easy when the symptoms are fully developed. However, the correct diagnosis of early Parkinson's disease is often difficult.1 The extent of misdiagnosis is directly related to the manifesting symptom.

We interviewed 100 consecutive patients with Parkinson's disease and found that 25% had received an incorrect original diagnosis. Tremor, gait disturbance, and dysgraphia caused minimal diagnostic problems. Rest tremor was the most frequent initial symptom (50% of cases), manifesting unilaterally, usually in the hand, and sometimes occurring intermittently.

The parkinsonian gait consists of a stooped posture, difficulty initiating the first step, small steps, and shuffling. The upper part of the body tends to be ahead of the feet, resulting in the propensity to run (propulsion). The gait associated with normal senescence may share some of these features, leading


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