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Can the early presence of autonomic dysfunction aid diagnosis in parkinsonism?
  1. Neurovascular Medicine Unit, Division of Neuroscience and Psychological Medicine, Imperial College School of Medicine at St Mary’s Hospital, Praed Street, London W2 1NY, UK and Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square and University Department of Clinical Neurology, Institute of Neurology, University College London, London WC1, UK.

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    Clinical, laboratory, and in particular neuropathological studies, indicate that parkinsonism is the presenting feature of a range of disorders. Although most are likely to have classic Parkinson’s disease (PD), a substantial number have disorders that include multiple system atrophy (MSA; about 10–15%), progressive supranuclear palsy (PSP), and relatively rare disorders such as dementia with Lewy bodies (DLB) and corticobasal degeneration (CBD). The natural history of these disorders varies widely. Laboratory tests have been used to help differentiate these disorders, but some are not readily accessible, most have been based on patients with established disease, and their sensitivity and specificity, especially in the early stages, are unknown. Clinical pointers therefore, …

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