Table 4 Reasons for change in clinical diagnosis
Patient NoBaseline diagnosisRevised diagnosisReason for change
1PDDLBCognitive decline with fluctuating confusion and visual hallucinations in first year.FP-CIT SPECT scan in keeping with degenerative parkinsonian syndrome.
2PDDLBEarly cognitive decline with fluctuating confusion and visual hallucinations.
3PDDLBEarly cognitive decline with fluctuating confusion and visual hallucinations. FP-CIT SPECT scan in keeping with degenerative parkinsonian syndrome.
4PDDLBEarly cognitive decline with fluctuating confusion and visual hallucinations.
5PDDLBCognitive decline with fluctuating confusion and visual hallucinations in first year.
6PDVascular parkinsonismExtensor plantar response on examination at review. Multiple vascular risk factors. CT brain scan showed extensive ischaemia.
7PDVascular parkinsonismNo response to levodopa. MRI brain scan showed extensive ischaemia, FP-CIT SPECT scan atypical.*
8PDDrug induced parkinsonismLevodopa had been started and prochlorperazine stopped before referral. No return of parkinsonism when levodopa stopped.
9PDDrug induced parkinsonismResolution of parkinsonism on stopping sodium valproate. Normal FP-CIT SPECT scan.
10PDEssential tremorNo progression. No response to levodopa. Development of head tremor. FP-CIT SPECT scan atypical.*
11PDEssential tremorLack of progression. FP-CIT SPECT scan showed grade 1 abnormality ipsilateral to tremor.
12PDEssential tremorLack of progression. No response to levodopa. Response of tremor to alcohol.
13PDFunctional tremorTremor not typical of parkinsonism. Underlying dementia. No definite bradykinesia at review. No rigidity. FP-CIT SPECT scan atypical.*
14DLBVascular parkinsonismNormal FP-CIT SPECT scan. MRI brain scan showed extensive ischaemia.
15Vascular parkinsonismPDGood response to levodopa. FP-CIT SPECT scan in keeping with degenerative parkinsonian syndrome.
16MSAPDExcellent and persistent response to levodopa. Development of dyskinesias and motor fluctuations. No persistence of autonomic features.
17PSPDLBNo slowing of vertical saccadic eye movements at review. Development of fluctuating confusion. Moderate response to levodopa.
18Alzheimer’s associated parkinsonismDLBParkinsonian rest tremor. Fluctuating confusion.
19Alzheimer’s associated parkinsonismVascular parkinsonismParkinsonism present early in course of dementia. Extensor plantar response on examination. Normal FP-CIT SPECT scan. Structural imaging not performed
20Essential tremorPDDevelopment of bradykinesia. Good response to levodopa. FP-CIT SPECT scan atypical.*
21Essential tremorPDDevelopment of shuffling gait and bradykinesia. Good response to levodopa. FP-CIT SPECT scan atypical.*
22Drug induced parkinsonismVascular parkinsonismResidual parkinsonism on withdrawal of prochlorperazine. MRI brain scan showed extensive ischaemia. Normal FP-CIT SPECT scan.
  • *FP-CIT scan showed punched out lesions not in keeping with the grading system used in degenerative parkinsonian syndromes. These were thought to be a result of cerebrovascular disease.

  • DLB, dementia with Lewy bodies; FP-CIT SPECT, N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)-tropane single photon emission computed tomography; MSA, multiple system atrophy; PD, Parkinson’s disease; PSP, progressive supranuclear palsy.