Diagnostic problems in Parkinson's disease.

The diagnosis of Parkinson's disease is not as easy as previously claimed, and presents a number of pitfalls. We present three rules, or aphorisms, to help the general practitioner in overcoming these diagnostic difficulties: Know well the basic disease and its symptoms. Use tricks to elicit apparently absent 'primary' symptoms. Beware of unusual symptoms or case histories. Examples of difficulties encountered at each level are given. Such analysis should permit the physician to classify his extrapyramidal patient within one of the many types of 'parkinsonism' as shown in Table 1.