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Drug-induced parkinsonism — SCE Geriatric Medicine MCQ

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HardMovement disordersDrug-induced parkinsonismSCE Geriatric Medicine

An 84-year-old developed symmetric bradykinesia and rigidity six months after risperidone was started. The drug is withdrawn, but disabling parkinsonism persists after four months. What is the most useful next diagnostic step?

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Correct answer: A — FP-CIT SPECT to assess for underlying nigrostriatal dopaminergic deficit

Persistent parkinsonism after dopamine-blocker withdrawal may represent unmasked degenerative disease. FP-CIT SPECT directly tests presynaptic dopaminergic deficit, whereas further observation delays clarification, structural MRI addresses different pathology, levodopa response is not diagnostic and autonomic testing does not distinguish pure drug-induced disease.

Reference: NICE NG71 Parkinson disease in adults: recommendations (Current NICE recommendations, accessed July 2026): https://www.nice.org.uk/guidance/ng71/chapter/Recommendations; EANM/SNMMI practice guideline for dopaminergic imaging in parkinsonian syndromes (Published 2020; current European and international specialist standard): https://pmc.ncbi.nlm.nih.gov/articles/PMC7300075/