UK PDS Brain Bank Criteria for the diagnosis of Parkinson's disease

Last reviewed 01/2018

Step 1. Diagnosis of a parkinsonian syndrome (1)

Bradykinesia and at least one of the following:
• muscular rigidity
• rest tremor (4–6 Hz)
• postural instability unrelated to primary visual, cerebellar, vestibular or proprioceptive dysfunction.

Step 2. Exclusion criteria for Parkinson's disease (PD)

History of :
• repeated strokes with stepwise progression
• repeated head injury
• antipsychotic or dopamine-depleting drugs
• definite encephalitis and/or oculogyric crises on no drug treatment
• more than one affected relative
• sustained remission
• negative response to large doses of levodopa (if malabsorption excluded)
• strictly unilateral features after 3 years
• other neurological features: supranuclear gaze palsy, cerebellar signs, early severe autonomic involvement, Babinski sign, early severe dementia with disturbances of language, memory or praxis
• exposure to known neurotoxin
• presence of cerebral tumour or communicating hydrocephalus on neuroimaging.

Step 3. Supportive criteria for PD

Three or more required for diagnosis of definite PD :

• unilateral onset
• excellent response to levodopa
• rest tremor present
• severe levodopa-induced chorea
• progressive disorder
• levodopa response for over 5 years
• persistent asymmetry affecting the side of onset most
• clinical course of over 10 years.
  

Reference:

• (1) Parkinson’s Disease.National clinical guideline for diagnosis and management in primary and secondary care. NICE full guideline.2006