Accuracy of clinical diagnosis of Parkinson disease
Kurt A.Jellinger, Director, Institute of Clinical Neurobiologykurt.jellinger@univie.ac.at
Submitted February 25, 2016
In a metaanalysis of 20 Parkinson disease (PD) studies, Rizzo et al. reported a pooled diagnostic accuracy of 80.6%, ranging from 61.5-95.7%. [1] The most frequent misdiagnoses among clinic-based studies were multiple system atrophy (MSA) (0-9.8%), Lewy body dementia (LBD) (0-7.9%), vascular encephalopathy (VaE) (0-7.7%), and progresssive supranuclear palsy (PSP) (0-6.5%). [1]
I reexamined a 50-year retrospective series of 604 patients with clinical diagnoses of PD from 900 autopsy-verified cases of parkinsonism in Austria, [2] using current diagnostic criteria. [3, 4] The diagnosis of idiopathic PD was confirmed neuropathologically in 80.3% of the total (25% associated with Alzheimer disease [AD]), whereas 19.7% had the following diagnoses: LBD (6.3%), MSA (4.0%), subcortical arteriosclerotic encephalopathy (SAE) (3.6%), PSP (3.0%), and others (AD, Pick disease, postencephalitic parkinsonism, vascular parkinsonism) (1.8%). [2] These data from a large clinic-based consecutive autopsy series of patients with the clinical diagnosis of PD are comparable with those of previous samples [5] and the systematic review of more than 2000 autopsy-confirmed cases of PD. [1] They all indicate that the currently available validity of a PD clinical diagnosis is still unsatisfactory and emphasize the need for further improvement of clinical criteria for PD using modern biomarkers.
1. Rizzo G, Copetti M, Arcuti S, et al. Accuracy of clinical diagnosis of Parkinson disease: A systematic review and meta-analysis. Neurology Epub 2016 Jan 13.
2. Jellinger KA. Morphological substrates of parkinsonism with and without dementia: a retrospective clinico-pathological study. J Neural Transm Suppl 2007;72:91-104.
3. Gibb WR, Lees AJ. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease. J Neurol Neurosurg Psychiatry 1988;51:745-752.
4. Jellinger KA. Parkinson's disease. In: Dickson DW, Weller RO, editors. Neurodegeneration: The Molecular Pathology of Dementia and Movement Disorders, 2nd Edition. Oxford: Wiley-Blackwell, 2011: 194-223.
5. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55:181-184.
For disclosures, please contact the editorial office at journal@neurology.org.
In a metaanalysis of 20 Parkinson disease (PD) studies, Rizzo et al. reported a pooled diagnostic accuracy of 80.6%, ranging from 61.5-95.7%. [1] The most frequent misdiagnoses among clinic-based studies were multiple system atrophy (MSA) (0-9.8%), Lewy body dementia (LBD) (0-7.9%), vascular encephalopathy (VaE) (0-7.7%), and progresssive supranuclear palsy (PSP) (0-6.5%). [1]
I reexamined a 50-year retrospective series of 604 patients with clinical diagnoses of PD from 900 autopsy-verified cases of parkinsonism in Austria, [2] using current diagnostic criteria. [3, 4] The diagnosis of idiopathic PD was confirmed neuropathologically in 80.3% of the total (25% associated with Alzheimer disease [AD]), whereas 19.7% had the following diagnoses: LBD (6.3%), MSA (4.0%), subcortical arteriosclerotic encephalopathy (SAE) (3.6%), PSP (3.0%), and others (AD, Pick disease, postencephalitic parkinsonism, vascular parkinsonism) (1.8%). [2] These data from a large clinic-based consecutive autopsy series of patients with the clinical diagnosis of PD are comparable with those of previous samples [5] and the systematic review of more than 2000 autopsy-confirmed cases of PD. [1] They all indicate that the currently available validity of a PD clinical diagnosis is still unsatisfactory and emphasize the need for further improvement of clinical criteria for PD using modern biomarkers.
1. Rizzo G, Copetti M, Arcuti S, et al. Accuracy of clinical diagnosis of Parkinson disease: A systematic review and meta-analysis. Neurology Epub 2016 Jan 13.
2. Jellinger KA. Morphological substrates of parkinsonism with and without dementia: a retrospective clinico-pathological study. J Neural Transm Suppl 2007;72:91-104.
3. Gibb WR, Lees AJ. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease. J Neurol Neurosurg Psychiatry 1988;51:745-752.
4. Jellinger KA. Parkinson's disease. In: Dickson DW, Weller RO, editors. Neurodegeneration: The Molecular Pathology of Dementia and Movement Disorders, 2nd Edition. Oxford: Wiley-Blackwell, 2011: 194-223.
5. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55:181-184.
For disclosures, please contact the editorial office at journal@neurology.org.