The odor stick identification test for Japanese differentiates Parkinson's disease from multiple system atrophy and progressive supra nuclear palsy

Suzuki, Masahiko; Hashimoto, Masaya; Yoshioka, Masayuki; Murakami, Maiko; Kawasaki, Kohkichi; Urashima, Mitsuyoshi

doi:10.1186/1471-2377-11-157

Cited by 45 publications

(25 citation statements)

References 33 publications

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“…A published meta‐analysis combining studies with smaller numbers of patients could substitute for one qualifying study (two other studies with >30 patients in each group are still required). Currently, olfactory loss and metaiodobenzylguanidine scintigraphy meet this threshold, but others may eventually qualify. Note that although dopaminergic neuroimaging can help distinguish parkinsonism (ie, degeneration of the nigrostriatal system) from PD‐mimics without parkinsonism (eg, essential tremor), it does not qualify as a criterion for the differentiation of PD from other parkinsonian conditions like atypical parkinsonian syndromes.…”

Section: Criteria Benchmark—the Expert Examinationmentioning

confidence: 99%

MDS clinical diagnostic criteria for Parkinson's disease

et al. 2015

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This document presents the Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's disease (PD). The Movement Disorder Society PD Criteria are intended for use in clinical research but also may be used to guide clinical diagnosis. The benchmark for these criteria is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise in PD diagnosis. Although motor abnormalities remain central, increasing recognition has been given to nonmotor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the Movement Disorder Society PD Criteria retain motor parkinsonism as the core feature of the disease, defined as bradykinesia plus rest tremor or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies on three categories of diagnostic features: absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of the PD diagnosis). Two levels of certainty are delineated: clinically established PD (maximizing specificity at the expense of reduced sensitivity) and probable PD (which balances sensitivity and specificity). The Movement Disorder Society criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, the Movement Disorder Society criteria will need continuous revision to accommodate these advances. © 2015 International Parkinson and Movement Disorder Society

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Section: Criteria Benchmark—the Expert Examinationmentioning

confidence: 99%

MDS clinical diagnostic criteria for Parkinson's disease

et al. 2015

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“…Thus, olfactory tests have been reported to be useful in differentiating PD from other atypical parkinsonian syndromes (APSs), such as multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) [6–8]. …”

Section: Introductionmentioning

confidence: 99%

Usefulness of Cardiac MIBG Scintigraphy, Olfactory Testing and Substantia Nigra Hyperechogenicity as Additional Diagnostic Markers for Distinguishing between Parkinson’s Disease and Atypical Parkinsonian Syndromes

et al. 2016

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BackgroundWe aimed to evaluate the utility of the combined use of cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy, olfactory testing, and substantia nigra (SN) hyperechogenicity on transcranial sonography (TCS) in differentiating Parkinson’s disease (PD) from atypical parkinsonian syndromes (APSs), such as multiple system atrophy (MSA) and progressive supranuclear palsy (PSP).MethodsCardiac MIBG scintigraphy, card-type odor identification testing (Open Essence (OE), Wako, Japan), and TCS were performed with 101 patients with PD and 38 patients with APSs (MSA and PSP). Receiver operating characteristic (ROC) curve analysis was used to assess the sensitivity and specificity of these batteries for diagnosing PD from APSs. The diagnostic accuracy of the three tests was also assessed among patients at the early disease stage (drug-naïve patients with a disease duration of 3 years or less).ResultsIn differentiating PD from APSs, the area under the ROC curve was 0.74 (95% CI, 0.65–0.83), 0.8 (95% CI, 0.73–0.87), and 0.75 (95% CI, 0.67–0.82) for TCS, cardiac MIBG scintigraphy, and olfactory testing, respectively. The diagnostic sensitivity and specificity were 53.1% and 91.7%, respectively, for TCS, 70.3% and 86.8%, respectively, for cardiac MIBG scintigraphy, 58.4% and 76.3%, respectively, for OE. Among early-stage patients, sensitivity and specificity were 50.0% and 93.8%, respectively, for TCS, 57.1% and 87.5%, respectively, for cardiac MIBG scintigraphy, and 54.8% and 79.2%, respectively, for OE. At least one positive result from 3 tests improved sensitivity (86.1%) but decreased specificity (63.2%). In contrast, at least 2 positive results from 3 tests had good discrimination for both early-stage patients (50.0% sensitivity and 93.8% specificity) and patients overall (57.8% sensitivity and 95.8% specificity). Positive results for all 3 tests yielded 100% specificity but low sensitivity (25%).ConclusionsAt least 2 positive results from among TCS, cardiac MIBG scintigraphy, and olfactory testing can support clinical diagnosis in distinguishing PD from APSs.

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“…NMS may provide clues to clinicians for the differential diagnosis of parkinsonian syndrome at onset. Olfactory loss (in the anosmic or clearly hyposmic range, adjusted for age and sex) has been included as an ancillary test in support of the PD diagnosis, because studies demonstrated specificity greater than 80% for differential diagnosis with other parkinsonian conditions . Another innovation promoted by MDS PD criteria is the inclusion of NMS among the red flags or warning signs, raising the clinical suspicion of an alternative diagnosis.…”

Section: Diagnostic Phasementioning

confidence: 99%

“…Olfactory loss (in the anosmic or clearly hyposmic range, adjusted for age and sex) has been included as an ancillary test in support of the PD diagnosis, because studies demonstrated specificity greater than 80% for differential diagnosis with other parkinsonian conditions. [49][50][51][52][53][54][55][56] Another innovation promoted by MDS PD criteria is the inclusion of NMS among the red flags or warning signs, raising the clinical suspicion of an alternative diagnosis. As such, although the absence of NMS suggests a PD-mimicking, nonparkinsonian condition, the excessive severity of specific NMS (such as autonomic failure) suggests an atypical parkinsonism (e.g., multiple system atrophy [MSA]).…”

Section: Clinical Biomarkersmentioning

confidence: 99%

Merging Clinical and Imaging Biomarkers to Tackle Parkinson's Disease

Picillo

Barone

Pellecchia

2017

Movement Disord Clin Pract

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Background In Parkinson's disease, biomarkers represent tools that are potentially suitable for either clinical or research settings and are useful in predicting onset, confirming diagnosis, detecting progression, and evaluating response to potential disease‐modifying treatments. The range of available biomarkers in Parkinson's disease is fast expanding and includes an increasing amount of laboratory, clinical, and imaging data. Indeed, the latter 2 represent the cornerstones of the diagnostic criteria for Parkinson's disease recently proposed by the International Parkinson and Movement Disorders Society Task Force on the definition of Parkinson's disease. Methods and Results In this review, we describe current knowledge and emerging findings on clinical (with emphasis on nonmotor symptoms) and imaging biomarkers for Parkinson's disease, with a focus on prodromal, diagnostic, and middle/advanced phases. Conclusion An increasing body of evidence suggests that merging clinical and imaging biomarkers through disease stages may be the best, fastest track to tackle Parkinson's disease.

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The odor stick identification test for Japanese differentiates Parkinson's disease from multiple system atrophy and progressive supra nuclear palsy

Cited by 45 publications

References 33 publications

MDS clinical diagnostic criteria for Parkinson's disease

MDS clinical diagnostic criteria for Parkinson's disease

Usefulness of Cardiac MIBG Scintigraphy, Olfactory Testing and Substantia Nigra Hyperechogenicity as Additional Diagnostic Markers for Distinguishing between Parkinson’s Disease and Atypical Parkinsonian Syndromes

Merging Clinical and Imaging Biomarkers to Tackle Parkinson's Disease

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