PARKINSONS-DISEASE - CLINICAL-FEATURES

Idiopathic Parkinson's disease (IPD) is a common and universal conditi on. Although its cause is still unknown, we now have some insights int o pathogenetic mechanisms and genetic factors that may be important in causing the selective neuronal loss and presence of Lewy bodies that characterize its pathology. Clinically, as well as the classic feature s of akinesia, rigidity and often rest tremor, patients may present a wide range of other symptoms including pain, other sensory symptoms, i mpaired olfaction, personality change, mild executive cognitive defici ts, dementia and depression, an extraordinary richness of symptoms and signs rendered even more extraordinary by the long-term effects of dr ug treatment. While there may be little difficulty recognizing typical cases of IPD, there has been, at least until recently, a considerable misdiagnosis rate in both atremulous (confusion with ageing, vascular disease, multiple system atrophy (MSA) or progressive supranuclear pa lsy (PSP)) and tremulous (confusion with essential tremor (ET), dyston ic tremor, and MSA) forms. However, increasing awareness of the clinic al features of all these conditions, together with adherence to exacti ng diagnostic criteria, is leading to improved diagnosis, which is cru cial for patients (who want to know what the future holds for them), f or their treatment (giving them the right drug and not the wrong one) and for research (since all the different diseases above have differen t aetiologies and pathology).