Differential diagnosis of parkinsonism with visual inspection of posture and gait in the early stage

Gait Posture. 2014 Apr;39(4):1138-41. doi: 10.1016/j.gaitpost.2014.01.004. Epub 2014 Jan 15.

Abstract

Background: Parkinson's disease (PD) differs from atypical parkinsonism in many clinical aspects. Principally, posture and gait are distinct features in the early stages of the disease; thus, these differences can be helpful in differential diagnosis.

Methods: We analyzed videos of patients with PD or atypical parkinsonism. A total of 76 patients with early PD (n=56) or atypical parkinsonism (n=20) were included. Items related to posture and gait were classified into three categories (standing, gait and associated symptoms) and each sub-item was analyzed.

Results: Asymmetric arm-swing (p=0.004) and accompanying tremor (p=0.016) were significant indicators of early-stage PD. Staggering gait (p=0.007) and en-bloc turning (p=0.026) were more common in atypical parkinsonism. Characteristics with a high odds-ratio for atypical parkinsonism were en-bloc turning (β=8.475, p=0.032) and normal arm-swing (β=14.6084, p=0.036).

Conclusions: Visual inspection of gait and posture provides reliable clues in the differential diagnosis of parkinsonism.

Keywords: Arm-swing; Atypical parkinsonism; Early stage; Parkinson's disease.

MeSH terms

  • Aged
  • Diagnosis, Differential
  • Early Diagnosis*
  • Female
  • Gait
  • Gait Disorders, Neurologic / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Parkinson Disease / diagnosis
  • Parkinson Disease / physiopathology
  • Parkinsonian Disorders / diagnosis*
  • Parkinsonian Disorders / physiopathology
  • Posture / physiology
  • Tremor / physiopathology
  • Upper Extremity / physiopathology
  • Video Recording