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Improving the diagnostic accuracy in parkinsonism: a three-pronged approach
  1. Marjolein B Aerts,
  2. Rianne A J Esselink,
  3. Bart Post,
  4. Bart P C van de Warrenburg,
  5. Bastiaan R Bloem
  1. Department of Neurology, Parkinson Center Nijmegen (ParC), and Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  1. Correspondence to Professor Bastiaan R Bloem, Department of Neurology, Parkinson Center Nijmegen (ParC) Radboud University Nijmegen Medical Centre PO Box 9101, 6500 HB, Nijmegen, The Netherlands; b.bloem{at}


Separating Parkinson's disease from the various causes of atypical parkinsonism (AP) is a common and clinically relevant challenge in clinical practice. Distinguishing between the different causes of AP is even more difficult. Here the authors discuss a systematic, clinically based and three-pronged approach that can assist clinicians in establishing the correct diagnosis in the consulting room. The three consecutive steps include: (1) to verify that the clinical syndrome truly represents parkinsonism (hypokinetic–rigid syndrome); (2) to search systematically for ‘red flags’ (alarm signs that may signal the presence of AP); and (3) to integrate these two steps, as a basis for a narrow differential diagnosis and a guide for further ancillary tests.

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  • Funding This work is supported by a research grant of the Stichting Internationaal Parkinson Fonds and the Van Alkemade-Keuls Fonds. These non-corporate funding organisations had no role on study design or conduct of the study, data collection, data analysis and interpretation or manuscript preparation

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Commissioned. Externally peer reviewed.

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