Abstract
The diagnosis of Parkinson’s disease (PD) is based on clinical features and differently to the common opinion that detecting this condition is easy, seminal clinicopathological studies have shown that up one-fourth of patients diagnosed as PD during life has an alternative diagnosis at postmortem. The misdiagnosis is even higher when only the initial diagnosis is considered, since the diagnostic accuracy improves by time, during follow-up visits. Given that the confirmation of the diagnosis of PD can be only obtained through neuropathology, to improve and facilitate the diagnostic–therapeutic workup in PD, a number of criteria and guidelines have been introduced in the last three decades. In the present paper, we will critically re-appraise the main diagnostic criteria proposed for PD, with particular attention to the recently published criteria by the International Parkinson and Movement Disorder Society (MDS) task force, underlying their novelty and focusing on the diagnostic issues still open. We also emphasize that the MDS-PD criteria encompass the two main previous sets of diagnostic criteria (United Kingdom PD Society Brain Bank and Gelb’s criteria), introducing at the same time new aspects as the use of non-motor symptoms as additional diagnostic features, and the adoption of the concept of prodromal PD, crucial to enroll in clinical trials PD patients in the very early phase of the disease. To better understand the real diffusion of the new MDS-PD diagnostic criteria among neurologists, we have also collected selective opinions of sixteen movement disorder experts from various world regions on their practical approach for the clinical diagnosis of PD. Results from this brief survey showed that, although innovative and complete, the revised diagnostic criteria produced by MDS task force are still scarcely employed among clinicians. We believe that both national and international scientific societies should operate in the future for a broader diffusion of these criteria with specific initiatives, including dedicated events and teaching courses.
Highlights
In the early 19th century, James Parkinson published his essay on “The Shaking Palsy,” in which he described in detail the clinical features of a new disease with an insidious onset and a progressive disabling course called paralysis agitans; he was inspired by the observation of various people he noted around the streets of London, all sharing these distinctive physical features [1, 2]
Addition, we performed an international audit by asking to sixteen movement disorder experts from all over the world, their practical approach toward the clinical diagnosis of Parkinson’s disease (PD) and their attitude regarding the application of the new criteria
These criteria, which have been developed for research purposes only, include a combination of markers ranging from mild motor symptoms [i.e., Unified Parkinson Disease Rating Scale (UPDRS)—1987 version [60] score ≥ 3 excluding action tremor; or Movement Disorder Society (MDS)-UPDRS score > 6 excluding postural-action tremor], non-motor symptoms (i.e., REM rapid eye movement sleep behavioral disorder (SBD), olfactory dysfunction, constipation, excessive daytime somnolence, symptomatic hypotension, erectile/ urinary dysfunction, depression), and ancillary diagnostic tests [41]
Summary
In the early 19th century, James Parkinson published his essay on “The Shaking Palsy,” in which he described in detail the clinical features (tremor, flexed posture, and festination) of a new disease with an insidious onset and a progressive disabling course called paralysis agitans; he was inspired by the observation of various people he noted around the streets of London, all sharing these distinctive physical features [1, 2]. Guidelines should provide comprehensive recommendations for the evaluation, diagnosis, treatment, and follow-up of patients with a given disorder and are usually developed by a task force of experts convened by an established scientific society who perform a systematic review of all published evidence on the topic. In this view, the collaborative European Federation of Neurological Societies/Movement Disorders Society-European Section (EFNS/MDS-ES) task force produced initially therapeutic [16, 17] and diagnostic [18] extensive guidelines for PD among others. Addition, we performed an international audit by asking to sixteen movement disorder experts from all over the world, their practical approach toward the clinical diagnosis of PD and their attitude regarding the application of the new criteria
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