History and exam
Key diagnostic factors
common
levodopa-unresponsive gait apraxia
Inability to walk in standing position, while able to make walking movements while lying.
Characterised by: a slow, cautious gait; gait initiation failure; unsteadiness (i.e., increased truncal sway while walking, retropulsion, widened standing base, impaired walking balance on tandem gait testing, impaired turning with 3 or more steps to turn 180 degrees); reduced stride length; shuffling gait; falls; and freezing.
Less commonly characterised by: festination (i.e., involuntary quickening of gait); tendency to get stuck in doorways; extrapyramidal (predominantly resting) tremor; and stooped posture.
Signs are symmetrical and predominantly affect the lower half of the body.
Generally insidious in onset over months or years.
Usually antedate other symptoms.[18]
Other diagnostic factors
common
cognitive impairment
Includes mental slowing (i.e., increased response latency, attention difficulties, impairment of abstract thinking and insight) and memory impairment (i.e., impaired recall, especially of recent events).
Generally insidious in onset, over months or years.
uncommon
urinary frequency, urgency, or incontinence
Not attributable to a primary urological disorder.
Generally insidious in onset, over months or years.
faecal incontinence
Occurs in advanced disease.
Risk factors
strong
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