TY - JOUR
T1 - Confirming Parkinson Disease Diagnosis
T2 - Patterns of Diagnostic Changes by Movement Disorder Specialists
AU - Keshtkarjahromi, Marzieh
AU - Abraham, Danielle S.
AU - Gruber-Baldini, Ann L.
AU - Schrader, Katrina
AU - Reich, Stephen G.
AU - Savitt, Joseph M.
AU - Von Coelln, Rainer
AU - Shulman, Lisa M.
N1 - Publisher Copyright:
© 2022 Marzieh Keshtkarjahromi et al.
PY - 2022
Y1 - 2022
N2 - Background. The American Academy of Neurology Parkinson Disease (PD) quality measures include an annual diagnostic review. Objective. To investigate the frequency and pattern of changes in diagnoses between PD and other causes of parkinsonism. Methods. This prospective longitudinal cohort study included consented patients diagnosed with PD at least once and a minimum of two times at the Movement Disorders Center between 2002 and 2017. Movement disorder specialists confirmed and documented diagnoses at every visit. Longitudinal changes in diagnoses were identified across visits. Results. Of 1567 patients with parkinsonism, 174 had non-PD parkinsonism with no change over time. Of 1393 patients diagnosed with PD at least once, 94% (N = 1308) had no change of diagnosis over time and 6% (N = 85) had a change of diagnosis including PD drug-induced parkinsonism (DIP) (27.1%), PD multiple system atrophy (MSA) (20.0%), PD progressive supranuclear palsy (PSP) (18.8%), PD Lewy body dementia (DLB) (16.5%), PDvascular parkinsonism (9.4%), more than two diagnoses (4.7%), and PD corticobasal syndrome (CBS) (3.5%). The direction of diagnostic switches was as follows: PD other parkinsonism diseases (36.5%), other parkinsonism diseases PD (31.8%), and 31.8% of multiple switches. There were no significant differences in duration of follow-up, age at first visit, gender, race, marital status, education, income, cognition, or employment between the stable and unstable groups. Diagnostic change was associated with greater PD severity and greater medical comorbidity. Conclusion. Over a 15-year period, movement disorder specialists changed their clinical diagnosis of PD in 6% of patients. The most common diagnostic switches, to or from PD, were DIP, MSA, PSP, and DLB. This study describes routine clinical diagnostic patterns in the absence of pathologic confirmation. The presence of diverse diagnostic changes over time underscores the value of confirming PD diagnosis.
AB - Background. The American Academy of Neurology Parkinson Disease (PD) quality measures include an annual diagnostic review. Objective. To investigate the frequency and pattern of changes in diagnoses between PD and other causes of parkinsonism. Methods. This prospective longitudinal cohort study included consented patients diagnosed with PD at least once and a minimum of two times at the Movement Disorders Center between 2002 and 2017. Movement disorder specialists confirmed and documented diagnoses at every visit. Longitudinal changes in diagnoses were identified across visits. Results. Of 1567 patients with parkinsonism, 174 had non-PD parkinsonism with no change over time. Of 1393 patients diagnosed with PD at least once, 94% (N = 1308) had no change of diagnosis over time and 6% (N = 85) had a change of diagnosis including PD drug-induced parkinsonism (DIP) (27.1%), PD multiple system atrophy (MSA) (20.0%), PD progressive supranuclear palsy (PSP) (18.8%), PD Lewy body dementia (DLB) (16.5%), PDvascular parkinsonism (9.4%), more than two diagnoses (4.7%), and PD corticobasal syndrome (CBS) (3.5%). The direction of diagnostic switches was as follows: PD other parkinsonism diseases (36.5%), other parkinsonism diseases PD (31.8%), and 31.8% of multiple switches. There were no significant differences in duration of follow-up, age at first visit, gender, race, marital status, education, income, cognition, or employment between the stable and unstable groups. Diagnostic change was associated with greater PD severity and greater medical comorbidity. Conclusion. Over a 15-year period, movement disorder specialists changed their clinical diagnosis of PD in 6% of patients. The most common diagnostic switches, to or from PD, were DIP, MSA, PSP, and DLB. This study describes routine clinical diagnostic patterns in the absence of pathologic confirmation. The presence of diverse diagnostic changes over time underscores the value of confirming PD diagnosis.
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U2 - 10.1155/2022/5535826
DO - 10.1155/2022/5535826
M3 - Article
C2 - 35585902
AN - SCOPUS:85130953018
SN - 2090-8083
VL - 2022
JO - Parkinson's Disease
JF - Parkinson's Disease
M1 - 5535826
ER -