Table 5

Helpful diagnostic hints

Parkinson's diseaseNon-parkinsonian tremorVascular parkinsonismAtypical parkinsonism
PD, Parkinson's disease.
• Classical pill rolling rest tremor• Lack of rigidity• Older age• More severe parkinsonian syndrome
• Good and sustained response to levodopa• Lack of bradykinesia• Hypertension• More rapid evolution
• Lack of other parkinsonian features, eg hypomimia, monotonous speech, abnormalities of gait or posture• Longer history of smoking• Greater postural instability
• History of previous strokes• Poor initial or current response to levodopa
• Abrupt onset with stepwise progression; more frequent gait difficulties; more severe postural instability• Incontinence
• Additional features incompatible with PD
• Intact cognition• Wide based small stepped gait
• Lack of falls• Less frequent tremor; no rest tremor; cognitive decline; pseudobulbar signs; pyramidal signs