MDS clinical diagnostic criteria for Parkinson's disease

Postuma, Ronald B.; Berg, Daniela; Stern, Matthew B.; Poewe, Werner; Olanow, C. Warren; Oertel, Wolfgang H.; Obeso, José A.; Marek, Kenneth; Litvan, Irene; Lang, Anthony E.; Halliday, Glenda M.; Goetz, Christopher G.; Gasser, Thomas; Dubois, Bruno; Chan, Piu; Bloem, Bastiaan R.; Adler, Charles H.; Deuschl, Günther

doi:10.1002/mds.26424

Cited by 5,133 publications

(4,126 citation statements)

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“…Interestingly, we were unable to identify a single case of PD associated with a normal scan thanks to our combined reassessment, even very early in the disease course, fully supporting the recently proposed MDS clinical criteria for PD, where a normal scan is considered an absolute exclusion criterion [29]. Based on our results and the confusing literature surrounding it, we concur with other researchers [30] that the very concept of SWEDD is clinically and scientifically highly problematic and should be definitely abandoned.…”

Section: Discussionsupporting

confidence: 82%

Scan without evidence of dopaminergic deficit: A 10-year retrospective study

Nicastro

Garibotto

Badoud

et al. 2016

Parkinsonism & Related Disorders

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Introduction: 123 I-ioflupane SPECT is a powerful method to assess nigrostriatal dopamine system integrity. Several independent studies have shown that 1e15% of patients with suspected degenerative parkinsonism, mainly PD, have scans without evidence of dopaminergic deficit (SWEDD). It has been proposed that most SWEDD patients either present with a non-degenerative condition mimicking PD, such as atypical tremor or dystonia, or demonstrate an abnormal scan when repeated later. We here hypothesized that scan interpretation methods may also play a crucial yet underestimated role in this issue. Methods: We previously established age-dependent reference values of striatal uptake by analyzing scans from a cohort of patients with non-degenerative conditions. We then studied a large population with well-established degenerative parkinsonism (N ¼ 410, 80% with PD), using identical imaging protocol, to evaluate the prevalence of patients with normal scans based on routine visual assessment. Each scan was eventually reassessed using the same automated method as for controls and a detailed 3D analysis. Results: Ten potential SWEDD cases (2.4%) were identified. However, both reassessment methods independently showed that these scans were all outside reference limits and/or visually abnormal when reexamined carefully, except for one case (0.2%) with corticobasal syndrome. Conclusion: SPECT misinterpretation emerges as an important contributor to the SWEDD population, suggesting that suspected SWEDD cases should prompt not only a serious diagnosis challenge but, equally important, a detailed scan reassessment. True SWEDD cases seem extremely rare in degenerative parkinsonism. We propose that the very concept of SWEDD is more confusing than helpful and should be definitely abandoned.

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Section: Discussionsupporting

confidence: 82%

Scan without evidence of dopaminergic deficit: A 10-year retrospective study

Nicastro

Garibotto

Badoud

et al. 2016

Parkinsonism & Related Disorders

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“…Olfactory testing has recently been incorporated in the newly established International Parkinson and Movement Disorder Society criteria for PD6 and prodromal PD 7…”

mentioning

confidence: 99%

Optimizing odor identification testing as quick and accurate diagnostic tool for Parkinson's disease

Mahlknecht

Pechlaner²,

Boesveldt

et al. 2016

Mov Disord.

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IntroductionThe aim of this study was to evaluate odor identification testing as a quick, cheap, and reliable tool to identify PD.MethodsOdor identification with the 16‐item Sniffin' Sticks test (SS‐16) was assessed in a total of 646 PD patients and 606 controls from three European centers (A, B, and C), as well as 75 patients with atypical parkinsonism or essential tremor and in a prospective cohort of 24 patients with idiopathic rapid eye movement sleep behavior disorder (center A). Reduced odor sets most discriminative for PD were determined in a discovery cohort derived from a random split of PD patients and controls from center A using L1‐regularized logistic regression. Diagnostic accuracy was assessed in the rest of the patients/controls as validation cohorts.ResultsOlfactory performance was lower in PD patients compared with controls and non‐PD patients in all cohorts (each P < 0.001). Both the full SS‐16 and a subscore of the top eight discriminating odors (SS‐8) were associated with an excellent discrimination of PD from controls (areas under the curve ≥0.90; sensitivities ≥83.3%; specificities ≥82.0%) and from non‐PD patients (areas under the curve ≥0.91; sensitivities ≥84.1%; specificities ≥84.0%) in all cohorts. This remained unchanged when patients with >3 years of disease duration were excluded from analysis. All 8 incident PD cases among patients with idiopathic rapid eye movement sleep behavior disorder were predicted with the SS‐16 and the SS‐8 (sensitivity, 100%; positive predictive value, 61.5%).ConclusionsOdor identification testing provides excellent diagnostic accuracy in the distinction of PD patients from controls and diagnostic mimics. A reduced set of eight odors could be used as a quick tool in the workup of patients presenting with parkinsonism and for PD risk indication. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society

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“…(14), (15) Investigation is going on to identify biomarkers of Parkinson's disease, but that will help in early diagnosis and slow progression of the disease. Agents currently under investigation are anti-apoptotics (Omigapil), anti-glutamatergics, monoamine oxidase inhibitors (Selegiline), promitochondrials (Coenzyme Q10, creatine), calcium channel blockers (Isradipine) and growth factors (GDNF).…”

Section: Futurementioning

confidence: 99%