Patient No | Baseline diagnosis | Revised diagnosis | Reason for change |
1 | PD | DLB | Cognitive decline with fluctuating confusion and visual hallucinations in first year.FP-CIT SPECT scan in keeping with degenerative parkinsonian syndrome. |
2 | PD | DLB | Early cognitive decline with fluctuating confusion and visual hallucinations. |
3 | PD | DLB | Early cognitive decline with fluctuating confusion and visual hallucinations. FP-CIT SPECT scan in keeping with degenerative parkinsonian syndrome. |
4 | PD | DLB | Early cognitive decline with fluctuating confusion and visual hallucinations. |
5 | PD | DLB | Cognitive decline with fluctuating confusion and visual hallucinations in first year. |
6 | PD | Vascular parkinsonism | Extensor plantar response on examination at review. Multiple vascular risk factors. CT brain scan showed extensive ischaemia. |
7 | PD | Vascular parkinsonism | No response to levodopa. MRI brain scan showed extensive ischaemia, FP-CIT SPECT scan atypical.* |
8 | PD | Drug induced parkinsonism | Levodopa had been started and prochlorperazine stopped before referral. No return of parkinsonism when levodopa stopped. |
9 | PD | Drug induced parkinsonism | Resolution of parkinsonism on stopping sodium valproate. Normal FP-CIT SPECT scan. |
10 | PD | Essential tremor | No progression. No response to levodopa. Development of head tremor. FP-CIT SPECT scan atypical.* |
11 | PD | Essential tremor | Lack of progression. FP-CIT SPECT scan showed grade 1 abnormality ipsilateral to tremor. |
12 | PD | Essential tremor | Lack of progression. No response to levodopa. Response of tremor to alcohol. |
13 | PD | Functional tremor | Tremor not typical of parkinsonism. Underlying dementia. No definite bradykinesia at review. No rigidity. FP-CIT SPECT scan atypical.* |
14 | DLB | Vascular parkinsonism | Normal FP-CIT SPECT scan. MRI brain scan showed extensive ischaemia. |
15 | Vascular parkinsonism | PD | Good response to levodopa. FP-CIT SPECT scan in keeping with degenerative parkinsonian syndrome. |
16 | MSA | PD | Excellent and persistent response to levodopa. Development of dyskinesias and motor fluctuations. No persistence of autonomic features. |
17 | PSP | DLB | No slowing of vertical saccadic eye movements at review. Development of fluctuating confusion. Moderate response to levodopa. |
18 | Alzheimer’s associated parkinsonism | DLB | Parkinsonian rest tremor. Fluctuating confusion. |
19 | Alzheimer’s associated parkinsonism | Vascular parkinsonism | Parkinsonism present early in course of dementia. Extensor plantar response on examination. Normal FP-CIT SPECT scan. Structural imaging not performed |
20 | Essential tremor | PD | Development of bradykinesia. Good response to levodopa. FP-CIT SPECT scan atypical.* |
21 | Essential tremor | PD | Development of shuffling gait and bradykinesia. Good response to levodopa. FP-CIT SPECT scan atypical.* |
22 | Drug induced parkinsonism | Vascular parkinsonism | Residual 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.