title: Approach to diagnosis of Parkinson disease.
abstract: OBJECTIVE
  To review the clinical features of Parkinson disease (PD) and other causes of motor parkinsonism with an emphasis on diagnosis in elderly patients. SOURCES OF INFORMATION MEDLINE: and Google Scholar were searched for original research articles describing clinical diagnosis of parkinsonism. Consensus statements and articles summarizing diagnostic criteria for parkinsonian syndromes were also reviewed. Most evidence was levels II or III.
  
  
  RESULTS
  Diagnosis of PD is made clinically and can be challenging. In older patients, PD can present with general functional decline and nonspecific symptoms. Clinical criteria for diagnosing PD and the TRAP mnemonic can be helpful. A 2-week trial of levodopa-carbidopa treatment can be considered. Specific signs and a minimal response to levodopa treatment suggest other causes of parkinsonism. Clinical features of other causes of parkinsonism are reviewed in the article.
  
  
  CONCLUSIONS
  Parkinsonism and PD are common in older patients. Family physicians should consider parkinsonism in the differential diagnosis of patients who have falls and exhibit general functional decline.
authors.affiliation: St Mary's of the Lake Hospital, Kingston, ON. frankc@pccchealth.org
authors.forename: Christopher
authors.initials: C
authors.lastname: Frank
authors.forename: Giovanna
authors.initials: G
authors.lastname: Pari
authors.forename: John P
authors.initials: JP
authors.lastname: Rossiter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000175:diagnosis* / Q000503:physiopathology; D020734:Parkinsonian Disorders / Q000175:diagnosis