Summary of recommendations for diagnosis and progression
| Recommendation number | Recommendation | Source | Grade |
|---|---|---|---|
| C7 | PD should be suspected in people presenting with tremor, stiffness, slowness, balance problems or gait disorders. | NICE7 | D GPP |
| C8 | PD can be diagnosed using the MDS Clinical Diagnostic Criteria. | CAN | GPP |
| C9 | Clinicians should be aware of the poor specificity of a clinical diagnosis of PD in the early stages of the disease, and consider this uncertainty when giving information to the patient and when planning management. | SIGN13 | C |
| C10 | Patients should be offered long-term, regular follow-up to review the diagnosis of PD. This should include a review of the ongoing benefits in those started on dopamine replacement therapy. | SIGN13 | GPP |
| C11 | Patients initially considered to have a possible diagnosis of PD may benefit from a trial of dopamine replacement therapy to assist with an accurate diagnosis. | SIGN13 | GPP |
| C12 | Patients with suspected PD, with substantial disability or exclusion criteria or red flags as per the MDS diagnostic criteria, should be seen by a clinician with sufficient expertise in movement disorders to make the diagnosis. | SIGN13 | C GPP |
| C13 | Acute challenge testing with either levodopa or apomorphine should not be used in the diagnosis of PD. Patients with suspected PD should be considered for a trial of chronic levodopa treatment. | SIGN13 | A |
| C14 | Objective olfactory testing is not recommended in the diagnosis of PD. | SIGN13 | B |
| C15 | Routine use of functional imaging is not recommended for the differential diagnosis of PD and Parkinson plus disorders such as progressive supranuclear palsy and multiple system atrophy. | SIGN13 | C |
| C16 | PET scanning is not recommended as part of the diagnostic work-up of parkinsonian syndromes, except within a research framework. | SIGN13 | GPP |
| C17 | 123I-FP-CIT SPECT scanning should be considered as an aid to clinical diagnosis in patients where there is uncertainty between PD and nondegenerative parkinsonism or tremor disorders. | SIGN13 | B |
| C18 | Computed tomography or MRI brain scanning should not be routinely applied in the diagnosis of idiopathic PD. | SIGN13 | C |
| C19 | Vitamin E should not be used as a neuroprotective therapy for people with PD. Co-enzyme Q10 should not be used as a neuroprotective therapy for people with PD. | NICE8 | A |
| C20 | Levodopa (grade: GPP), amantadine (grade: GPP), dopamine agonists (pramipexole, ropinirole, rotigotine, apomorphine, bromocriptine) (grade: A), or MAO inhibitors (selegiline, rasagiline) (grade: A) should not be used as neuroprotective therapies for people with PD, except in the context of clinical trials. | CAN | Varied |
| C21 | Genetic testing for monogenic parkinsonism is not recommended in routine clinical practice. | SIGN13 | GPP |
| C22 | Patients who request genetic testing, particularly those with young-onset parkinsonism, should be assessed in a specialist movement disorders clinic for consideration of counselling and testing. | SIGN13 | GPP |
Note: 123I-FP-CIT = 123I-ioflupane, CAN = new Canadian Guideline recommendation, GPP = good practice point, MAO = monoamine oxidase, MDS = Movement Disorder Society Evidence-Based Medicine Review,16 MRI = magnetic resonance imaging, NICE7 = National Institute for Health and Clinical Excellence 2006 PD Guidelines,7 NICE8 = National Institute for Health and Clinical Excellence — 2017 PD Guidelines,8 PD = Parkinson disease, PET = positron emission tomography, SIGN13 = Scottish Intercollegiate Guidelines Network,13 SPECT = single-photon emission computed tomography.