Summary

This section discussed the clinical examination of patients for whom a diagnosis of Parkinson's disease is most likely. The examination usually consists of:

• History-taking
• Examination of initially presenting symptoms (often tremor, rigidity, akinesia/bradykinesia, and/or postural changes)
• Administration of levodopa or a dopamine agonist
• Magnetic resonance imaging (MRI)
• In some cases, additional nuclear imaging such as PET or SPECT scanning is employed, but typically are reserved for research.

Presently, there is no definitive diagnostic test for Parkinson's disease, except, unfortunately, at autopsy through confirmation of the loss of dopaminergic neurons as seen in depigmentation of the substantia nigra pars compacta. Post-mortem, it is also possible to document the presence of Lewy bodies, which may be a protective mechanism in the course of neuronal death or part of the pathogenetic mechanism of Parkinson's disease.

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