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Parkinsonism Relat Disord. 2017 Jul;40:40-46. doi: 10.1016/j.parkreldis.2017.04.006. Epub 2017 Apr 12.

Utility of the new Movement Disorder Society clinical diagnostic criteria for Parkinson's disease applied retrospectively in a large cohort study of recent onset cases.

Author information

1
Department of Neurology, Ipswich Hospital NHS Trust, Ipswich, United Kingdom. Electronic address: nmalek@nhs.net.
2
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
3
Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
4
Department of Neurology, Queen's Medical Centre, Nottingham, United Kingdom.
5
Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, Cambridge, United Kingdom.
6
Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, United Kingdom.
7
Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, United Kingdom.
8
Reta Lila Weston Laboratories, Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom.
9
Department of Clinical Neuroscience, UCL Institute of Neurology, London, United Kingdom.
10
Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom.
11
Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom.

Abstract

OBJECTIVE:

To examine the utility of the new Movement Disorder Society (MDS) diagnostic criteria in a large cohort of Parkinson's disease (PD) patients.

METHODS:

Recently diagnosed (<3.5 years) PD cases fulfilling United Kingdom (UK) brain bank criteria in Tracking Parkinson's, a UK multicenter prospective natural history study were assessed by retrospective application of the MDS criteria.

RESULTS:

In 2000 cases, 1835 (91.7%) met MDS criteria for PD, either clinically established (n = 1261, 63.1%) or clinically probable (n = 574, 28.7%), leaving 165 (8.3%) not fulfilling criteria. Clinically established cases were significantly more likely to have limb rest tremor (89.3%), a good l-dopa response (79.5%), and olfactory loss (71.1%), than clinically probable cases (60.6%, 44.4%, and 34.5% respectively), but differences between probable PD and 'not PD' cases were less evident. In cases not fulfilling criteria, the mean MDS UPDRS3 score (25.1, SD 13.2) was significantly higher than in probable PD (22.3, SD 12.7, p = 0.016) but not established PD (22.9, SD 12.0, p = 0.066). The l-dopa equivalent daily dose of 341 mg (SD 261) in non-PD cases was significantly higher than in probable PD (250 mg, SD 214, p < 0.001) and established PD (308 mg, SD 199, p = 0.025). After 30 months' follow-up, 89.5% of clinically established cases at baseline remained as PD (established/probable), and 86.9% of those categorized as clinically probable at baseline remained as PD (established/probable). Cases not fulfilling PD criteria had more severe parkinsonism, in particular relating to postural instability, gait problems, and cognitive impairment.

CONCLUSION:

Over 90% of cases clinically diagnosed as early PD fulfilled the MDS criteria for PD. Those not fulfilling criteria may have an atypical parkinsonian disorder or secondary parkinsonism that is not correctly identified by the UK Brain Bank criteria, but possibly by the new criteria.

KEYWORDS:

Criteria; Diagnosis; Parkinson's disease; Phenotype

PMID:
28431829
PMCID:
PMC5570813
DOI:
10.1016/j.parkreldis.2017.04.006
[Indexed for MEDLINE]
Free PMC Article

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