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October 30, 2020Research

Clinical Diagnostic Accuracy of Early/Advanced Parkinson Disease: Updated Clinicopathologic Study

Charles H. Adler, Thomas G. Beach, Nan Zhang, Holly A. Shill, Erika Driver-Dunckley, Shyamal H. Mehta, Alireza Atri, John N. Caviness, Geidy Serrano, David R. Shprecher, Lucia I. Sue, Christine M. Belden
First published October 30, 2020, DOI: https://doi.org/10.1212/CPJ.0000000000001016
Charles H. Adler
1Parkinson’s Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
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Thomas G. Beach
2Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ
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Nan Zhang
3Department of Biostatistics, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
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Holly A. Shill
4Barrow Neurologic Institute, Phoenix, AZ
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Erika Driver-Dunckley
1Parkinson’s Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
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Shyamal H. Mehta
1Parkinson’s Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
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Alireza Atri
5Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, AZ
6Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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John N. Caviness
1Parkinson’s Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ
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Geidy Serrano
2Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ
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David R. Shprecher
5Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, AZ
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Lucia I. Sue
2Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ
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Christine M. Belden
5Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, AZ
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Citation
Clinical Diagnostic Accuracy of Early/Advanced Parkinson Disease: Updated Clinicopathologic Study
Charles H. Adler, Thomas G. Beach, Nan Zhang, Holly A. Shill, Erika Driver-Dunckley, Shyamal H. Mehta, Alireza Atri, John N. Caviness, Geidy Serrano, David R. Shprecher, Lucia I. Sue, Christine M. Belden
Neurol Clin Pract Oct 2020, 10.1212/CPJ.0000000000001016; DOI: 10.1212/CPJ.0000000000001016

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Abstract

Objectives: Update data for diagnostic accuracy of a clinical diagnosis of Parkinson’s disease (PD) using neuropathological diagnosis as the gold standard.

Methods: Data from the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND) was used to determine the predictive value of a clinical PD diagnosis. Two clinical diagnostic confidence levels were used, Possible PD (PossPD, never treated or not responsive) and Probable PD (ProbPD, 2/3 cardinal clinical signs + responsive to dopaminergic medications). Neuropathological diagnosis was the gold standard.

Results: Based on first visit to AZSAND, 15/54 (27.8%) PossPD cases and 138/163 (84.7%) ProbPD had confirmed PD. PD was confirmed in 24/34 (70.6%) ProbPD with <5 yrs and 114/128 (89.1%) with >5 yrs disease duration. Using the consensus final clinical diagnosis following death, 161/187 (86.1%) ProbPD had neuropathologically confirmed PD. Diagnostic accuracy for ProbPD improved if included motor fluctuations, dyskinesias, and hyposmia, and hyposmia for PossPD.

Conclusions: This updated study confirmed lower clinical diagnostic accuracy for elderly, untreated or poorly responsive PossPD participants and for ProbPD with <5 yr disease duration, even when medication responsive. Caution continues to be needed when interpreting clinical studies of PD, especially studies of early disease, that do not have autopsy confirmation.

Classification of Evidence: This study provides Class II evidence that a clinical diagnosis of probable PD at first visit identifies patients who will have pathologically confirmed PD with a sensitivity of 82.6% and specificity of 86.0%.

  • Received July 22, 2020.
  • Accepted October 1, 2020.
  • © 2020 American Academy of Neurology

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