Refer all people with suspected Parkinson's disease urgently, and untreated, to a specialist with appropriate expertise in movement disorders, such as a neurologist or elderly care physician, to confirm the diagnosis and exclude alternative diagnoses NICE CKS.
Refer adults with suspected parkinsonian tremor, other asymmetric tremor, or tremor associated with stiffness, slowness, balance problems or gait disorders for neurological assessment before treatment NICE CKS.
Refer adults with suspected Parkinson's disease if they present with tremor, stiffness, slowness, balance problems, or gait disorders, to ensure accurate diagnosis and management NICE NG71.
Arrange urgent specialist referral before starting drug treatment, as drug treatment can mask signs needed for diagnosis, and early specialist assessment helps prevent misdiagnosis NICE CKS.
Refer if there are atypical features or if the clinical presentation suggests alternative diagnoses such as atypical parkinsonism or other neurological conditions NICE CKS.