Table 4 Reasons for change in clinical diagnosis

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.