PARKINSONS & PARKINSONISM-RED FLAGS

SUMMARY

1. Rapid progression of gait impairment, requiring a wheelchair within 5 yrs of onset
2. Absence of progression of motor symptoms or signs over 5 yrs or more (absent treatment)
3. Early bulbar dysfunction (< 5 yrs from onset)
4. Respiratory dysfunction (stridor, frequent sighs)
5. Severe autonomic failure (< 5 yrs from onset)
6. Recurrent (>1/yr) falls from imbalance within 3 yrs of onset
7. Anterocollis or limb contractures within 10 yrs of onset
8. Absence of common non-motor features (sleep dysfunction, rapid eye movement behaviour disorder [RBD], RLS/PLMS, daytime somnolence, autonomic dysfunction, hyposmia, mood disturbance)
9. Otherwise unexplained pyramidal tract signs
10. Bilateral symmetric parkinsonism

Key: RBD, REM-sleep behavior disorder; RLS, restless leg syndrome; PLMS, periodic limb movements of sleep; FTD, frontotemporal dementia; PPA, primary progressive aphasia; UPDRS, Unified Parkinson Disease Rating Scale.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].