This chapter provides an in-depth discussion of how current neuroimaging techniques can aid the clinician in the diagnosis of patients with parkinsonian symptoms. Although clinical assessment and structural imaging can rule out secondary causes, several functional imaging techniques are available to help the clinician with a critical diagnostic question—whether the symptoms are due to idiopathic Parkinson’s disease (PD) versus an alternative parkinsonian syndrome. If the symptoms are due to an alternative non-PD syndrome, the clinician must determine which one. The chapter reviews how the presenting symptom complex and the differential diagnosis can be used to choose the most informative imaging strategy. Clinical applications of imaging for parkinsonism are discussed in terms of the predominant presenting features, such as akinetic rigidity, tremor, or cognitive dysfunction (dementia). New metabolic imaging data on the use of brain networks to classify individual subjects are also discussed.
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