I. Clinical features according to diagnostic utility
A. Group A: Characteristic of Parkinson's disease
1. Resting tremor.
4. Asymmetric onset.
B. Group B: Suggestive of other diseases
1. Features unusual early in the disease:
a. Prominent postural instability within the first 3 years of the disease.
b. Freezing phenomena in the first 3 years.
c. Hallucinations unrelated to medications in the first 3 years.
d. Dementia preceding motor symptoms or in the first year:
i. Supranuclear gaze palsy (other than upgaze restriction) or slowing of saccades.
ii. Severe, symptomatic dysautonomia unrelated to medications.
iii. Documentation of a lesion or condition associated with parkinsonism and plausibly connected to the patient's symptom (e.g., focal brain lesion or recent neuroleptic exposure).
II. Possible Parkinson's disease
A. At least two of four group A symptoms, at least one of which is tremor or bradykinesia And
B. Either no group B symptoms Or
Symptoms less than 3 years duration, and none of the group B symptoms are present to date And
C. Either substantial and sustained response to levodopa or a dopamine agonist has been documented Or
Patient has not had an adequate trial of levodopa or a dopamine agonist.
III. Probable Parkinson's disease
A. At least three group A symptoms are present And
B. No group B symptoms present for those with symptoms over 3 years And
C. Substantial and sustained response to levodopa or a dopamine agonist has been documented.
IV. Definite Parkinson's disease
A. All criteria for possible or probable Parkinson's disease are met And
B. Histopathological confirmation of the diagnosis
Adapted with permission from Gelb DJ, Oliver E, Gilman S. Diagnostic criteria for Parkinson's disease. Arch Neurol 1999;56:33-39.
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