When should I consider referring a patient with parkinsonism to a neurologist for further evaluation?

Consider referring a patient with parkinsonism to a neurologist for further evaluation if:

• They present with symptoms suggestive of Parkinson's disease such as tremor, stiffness, slowness, balance problems, and/or gait disorders, especially if the diagnosis is uncertain or the patient is untreated. Early specialist assessment is recommended to confirm diagnosis and guide management NICE NG71.
• They have suspected parkinsonian tremor, asymmetric tremor, or tremor associated with stiffness, slowness, balance problems, or gait disorders, before starting treatment NICE NG127.
• There is difficulty with handwriting characterized by small and slow writing, which may indicate parkinsonism NICE NG127.

Referral should be prompt to a specialist with expertise in differential diagnosis of Parkinson's disease to ensure accurate diagnosis and appropriate management NICE NG71.