Journal of Neural Transmission

, Volume 120, Issue 4, pp 619–625 | Cite as

Different diagnostic criteria for Parkinson disease: what are the pitfalls?

  • Roongroj Bhidayasiri
  • Heinz Reichmann
Neurology and Preclinical Neurological Studies - Review Article


As there are no definite diagnostic tests or reliable biomarkers for Parkinson disease (PD), its diagnosis still relies on the presence of a combination of cardinal motor features, along with the exclusion of other causes of Parkinsonism and the presence of some of supportive features. To date, several diagnostic criteria have been developed for different purposes through expert opinions or comprehensive review of the literature. However, none of them are without limitations. In this article, we review different diagnostic criteria for PD which have been published in the English medical literature, highlighting specific limitations and pitfalls. With considerable progress in the understanding of PD, particularly in a view of diverse clinical symptomatology and its evolution, it will be difficult to establish a single criterion that is capable of capturing all cases at different disease stages. Rather, we should aim to develop a set of criteria which include a consensus on clinical gold standard or reliable biomarkers at different levels of diagnostic certainty for different purposes. Despite a more refined set of criteria that may aid in the recognition of PD, the accuracy of its diagnosis still largely depends on the observational skills and clinical sensitivity of the treating physician.


Parkinson disease Diagnostic criteria Biomarkers Preclinical Pitfalls 



The study was supported by the Rachadaphiseksomphot Endowment Fund part of the “Strengthen CU's Researcher’s Project” and research unit grant number GRU 52-026-30-005 of Chulalongkorn University, Bangkok, Thailand.

Conflict of interest



  1. Bhidayasiri R, Truong DD (2012) Therapeutic strategies for nonmotor symptoms in early Parkinson’s disease: the case for a higher priority and stronger evidence. Parkinsonism Relat Disord 18(Suppl 1):S110–S113PubMedCrossRefGoogle Scholar
  2. Bhidayasiri R, Saksornchai K, Kaewwilai L, Phanthumchinda K (2011a) A census of movement disorders at a Thai university hospital. J Neurol Sci 301(1–2):31–34PubMedCrossRefGoogle Scholar
  3. Bhidayasiri R, Wannachai N, Limpabandhu S, Choeytim S, Suchonwanich Y, Tananyakul S et al (2011b) A national registry to determine the distribution and prevalence of Parkinson’s disease in Thailand: implications of urbanization and pesticides as risk factors for Parkinson’s disease. Neuroepidemiology 37(3–4):222–230PubMedCrossRefGoogle Scholar
  4. Brooks DJ (2012) Parkinson’s disease: diagnosis. Parkinsonism Relat Disord 18(Suppl 1):S31–S33PubMedCrossRefGoogle Scholar
  5. Busse K, Heilmann R, Kleinschmidt S, Abu-Mugheisib M, Hoppner J, Wunderlich C et al (2012) Value of combined midbrain sonography, olfactory and motor function assessment in the differential diagnosis of early Parkinson’s disease. J Neurol Neurosurg Psychiatry 83(4):441–447PubMedCrossRefGoogle Scholar
  6. Calne DB, Snow BJ, Lee C (1992) Criteria for diagnosing Parkinson’s disease. Ann Neurol 32(Suppl):S125–S127PubMedCrossRefGoogle Scholar
  7. Coelho M, Ferreira JJ (2012) Late-stage Parkinson disease. Nat Rev Neurol 8(8):435–442PubMedGoogle Scholar
  8. de Rijk MC, Rocca WA, Anderson DW, Melcon MO, Breteler MM, Maraganore DM (1997) A population perspective on diagnostic criteria for Parkinson’s disease. Neurology 48(5):1277–1281PubMedCrossRefGoogle Scholar
  9. Dotchin C, Walker R (2012) The management of Parkinson’s disease in sub-Saharan Africa. Expert Rev Neurother 12(6):661–666PubMedCrossRefGoogle Scholar
  10. Fahn S (2011) Classification of movement disorders. Mov Disord 26(6):947–957PubMedCrossRefGoogle Scholar
  11. Fahn S, Jankovic J, Hallett M (2011) Parkinsonism: clinical features and differential diagnosis. In: Fahn S, Jankovic J, Hallett M (eds) Principles and practice of movement disorders. Saunders, USA, pp 66–92CrossRefGoogle Scholar
  12. Forno LS (1987) The Lewy body in Parkinson’s disease. Adv Neurol 45:35–43PubMedGoogle Scholar
  13. Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson disease. Arch Neurol 56(1):33–39PubMedCrossRefGoogle Scholar
  14. Gibb WR, Lees AJ (1988) The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 51(6):745–752PubMedCrossRefGoogle Scholar
  15. Han M, Nagele E, DeMarshall C, Acharya N, Nagele R (2012) Diagnosis of Parkinson’s disease based on disease-specific autoantibody profiles in human sera. PLoS ONE 7(2):e32383PubMedCrossRefGoogle Scholar
  16. Hely MA, Reid WG, Adena MA, Halliday GM, Morris JG (2008) The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Mov Disord 23(6):837–844PubMedCrossRefGoogle Scholar
  17. Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17(5):427–442PubMedCrossRefGoogle Scholar
  18. Hughes AJ, Ben-Shlomo Y, Daniel SE, Lees AJ (1992a) What features improve the accuracy of clinical diagnosis in Parkinson’s disease: a clinicopathologic study. Neurology 42(6):1142–1146PubMedCrossRefGoogle Scholar
  19. Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992b) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinic-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184PubMedCrossRefGoogle Scholar
  20. Hughes AJ, Daniel SE, Blankson S, Lees AJ (1993a) A clinicopathologic study of 100 cases of Parkinson’s disease. Arch Neurol 50(2):140–148PubMedCrossRefGoogle Scholar
  21. Hughes AJ, Daniel SE, Lees AJ (1993b) The clinical features of Parkinson’s disease in 100 histologically proven cases. Adv Neurol 60:595–599PubMedGoogle Scholar
  22. Hughes AJ, Daniel SE, Lees AJ (2001) Improved accuracy of clinical diagnosis of Lewy body Parkinson’s disease. Neurology 57:1497–1499PubMedCrossRefGoogle Scholar
  23. Hughes AJ, Daniel SE, Ben Shlomo Y, Lees AJ (2002) The accuracy of diagnosis pf parkinsonian syndromes in a specialist movement disorder service. Brain 125:861–870PubMedCrossRefGoogle Scholar
  24. Koller WC (1992) How accurately can Parkinson’s disease be diagnosed? Neurology 42(1 Suppl 1):6–16 (discussion 57–60)PubMedGoogle Scholar
  25. Larsen JP, Dupont E, Tandberg E (1994) Clinical diagnosis of Parkinson’s disease. Proposal of diagnostic subgroups classified at different levels of confidence. Acta Neurol Scand 89(4):242–251PubMedCrossRefGoogle Scholar
  26. Louis ED, Klatka LA, Liu Y, Fahn S (1997) Comparison of extrapyramidal features in 31 pathologically confirmed cases of diffuse Lewy body disease and 34 pathologically confirmed cases of Parkinson’s disease. Neurology 48(2):376–380PubMedCrossRefGoogle Scholar
  27. Martin WE, Loewenson RB, Resch JA, Baker AB (1973) Parkinson’s disease. Clinical analysis of 100 patients. Neurology 23(8):783–790PubMedCrossRefGoogle Scholar
  28. Meara J, Bhowmick BK, Hobson P (1999) Accuracy of diagnosis in patients with presumed Parkinson’s disease. Age Ageing 28(2):99–102PubMedCrossRefGoogle Scholar
  29. O’Sullivan SS, Williams DR, Gallagher DA, Massey LA, Silveira-Moriyama L, Lees AJ (2008) Nonmotor symptoms as presenting complaints in Parkinson’s disease: a clinicopathological study. Mov Disord 23(1):101–106PubMedCrossRefGoogle Scholar
  30. Ozcift A (2012) SVM feature selection based rotation forest ensemble classifiers to improve computer-aided diagnosis of Parkinson disease. J Med Syst 36(4):2141–2147PubMedCrossRefGoogle Scholar
  31. Quinn N (1995) Parkinsonism–recognition and differential diagnosis. BMJ 310(6977):447–452PubMedCrossRefGoogle Scholar
  32. Rajput AH, Rozdilsky B, Ang L (1991a) Occurrence of resting tremor in Parkinson’s disease. Neurology 41(8):1298–1299PubMedCrossRefGoogle Scholar
  33. Rajput AH, Rozdilsky B, Rajput A (1991b) Accuracy of clinical diagnosis in Parkinsonism–a prospective study. Can J Neurol Sci 18(3):275–278PubMedGoogle Scholar
  34. Rao G, Fisch L, Srinivasan S, D’Amico F, Okada T, Eaton C et al (2003) Does this patient have Parkinson disease? JAMA 289(3):347–353PubMedCrossRefGoogle Scholar
  35. Reichmann H (2010) Clinical criteria for the diagnosis of Parkinson’s disease. Neurodegener Dis 7(5):284–290PubMedCrossRefGoogle Scholar
  36. Schrag A, Ben-Shlomo Y, Quinn N (2002) How valid is the clinical diagnosis of Parkinson’s disease in the community? J Neurol Neurosurg Psychiatry 73(5):529–534PubMedCrossRefGoogle Scholar
  37. Shi FD, Jia JP (2011) Neurology and neurologic practice in China. Neurology 77(22):1986–1992PubMedCrossRefGoogle Scholar
  38. Siderowf A, Stern MB (2008) Premotor Parkinson’s disease: clinical features, detection, and prospects for treatment. Ann Neurol 64(Suppl 2):S139–S147PubMedGoogle Scholar
  39. Stern MB, Lang A, Poewe W (2012) Toward a redefinition of Parkinson’s disease. Mov Disord 27(1):54–60PubMedCrossRefGoogle Scholar
  40. van de Loo S, Walter U, Behnke S, Hagenah J, Lorenz M, Sitzer M et al (2010) Reproducibility and diagnostic accuracy of substantia nigra sonography for the diagnosis of Parkinson’s disease. J Neurol Neurosurg Psychiatry 81(10):1087–1092PubMedCrossRefGoogle Scholar
  41. van Rooden SM, Heiser WJ, Kok JN, Verbaan D, van Hilten JJ, Marinus J (2010) The identification of Parkinson’s disease subtypes using cluster analysis: a systematic review. Mov Disord 25(8):969–978PubMedCrossRefGoogle Scholar
  42. van Rooden SM, Colas F, Martinez-Martin P, Visser M, Verbaan D, Marinus J et al (2011) Clinical subtypes of Parkinson’s disease. Mov Disord 26(1):51–58PubMedCrossRefGoogle Scholar
  43. Ward CD, Gibb WR (1990) Research diagnostic criteria for Parkinson’s disease. Adv Neurol 53:245–249PubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  1. 1.Chulalongkorn Center of Excellence on Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand
  2. 2.Department of NeurologyGeffen School of Medicine at UCLALos AngelesUSA
  3. 3.Klinik und Poliklinik fur Neurologie, Universitatsklinikum Carl Gustav CarusDresdenGermany

Personalised recommendations