Accurate diagnosis of Parkinson’s disease (PD) requires distinguishing it from disorders with overlapping symptoms. Here are key conditions to differentiate:
1. Secondary Parkinsonism
- Causes: Drug-induced (neuroleptics, reserpine, metoclopramide), toxins (CO, manganese, MPTP), vascular lesions (multiple infarcts), or post-encephalitic syndromes.
- Clues: Reversible with drug withdrawal, imaging evidence of infarcts, or history of toxin exposure.
2. Wilson’s Disease
- Features: Autosomal recessive,青少年 onset, liver dysfunction, Kayser-Fleischer rings, low serum ceruloplasmin.
- Key: Liver damage and copper metabolism abnormalities rule out PD.
3. Essential Tremor
- Signs: Action tremor (head, limbs) without bradykinesia or rigidity; improves with alcohol or propranolol.
4. Progressive Supranuclear Palsy (PSP)
- Red Flags: Vertical gaze palsy, early falls, minimal tremor, poor response to levodopa.
5. Major Depression
- Overlap: Apathy mimics PD motor symptoms, but lacks rigidity/tremor. Antidepressants aid diagnosis.
6. Dementia with Lewy Bodies (DLB)
- Triad: Early dementia, visual hallucinations, parkinsonism. Poor levodopa response, high sensitivity to side effects.
7. Huntington’s Disease
- Differentiators: Family history, chorea, cognitive decline; rigidity subtype may mimic PD.
8. Multiple System Atrophy (MSA)
- Subtypes: Parkinsonism (MSA-P), cerebellar (MSA-C), autonomic failure. Levodopa resistance and MRI findings (pontine atrophy) confirm.
9. Corticobasal Degeneration (CBD)
- Cortical Signs: Apraxia, alien limb syndrome, cortical sensory loss. Levodopa ineffective.
Key Takeaways:
- PD mimics include drug-induced parkinsonism, Wilson’s disease, and atypical parkinsonian disorders (PSP, MSA).
- Lab tests (ceruloplasmin), imaging (MRI), and medication response (levodopa) are critical for accurate diagnosis.
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