Clinicopathologic discrepancies in a population-based incidence study of parkinsonism in olmsted county: 1991-2010

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Abstract

Objective: The purpose of this study was to examine the discrepancies between the clinical diagnosis of parkinsonism and neuropathological findings in a population-based cohort with parkinsonian disorders. Background: The specific clinical diagnosis of parkinsonism is challenging, and definite confirmation requires neuropathological evaluation. Currently, autopsies are seldom performed, and most brain autopsies represent atypical or diagnostically unresolved cases. Methods: We used a defined population-based incidence cohort with clinical parkinsonism (n=669) from the Rochester Epidemiology Project in Olmsted County, Minnesota, 1991-2010. We reviewed reports of all patients who underwent neuropathologic examination at autopsy (n=60; 9%) and applied consensus pathologic guidelines for neurodegenerative disease diagnosis. Results: Among the 60 patients examined pathologically, the median time from the last recorded clinical diagnosis to death was 7 years (range from 2 to 17 years). Clinical-pathological concordance was found in 52 cases (86.7%), whereas 8 (13.3%) had a clinical-pathological discrepancy. Four patients with a clinical diagnosis of idiopathic Parkinson's disease had no pathological evidence of Lewy bodies or α-synucleinopathy; of these, pathological diagnoses were Alzheimer's disease (2 cases), progressive supranuclear palsy (1 case), and vascular parkinsonism (1 case). Two patients with clinical diagnoses of "dementia with Lewy bodies" and one patient with an "unspecified parkinsonism" had a pathological diagnosis of Alzheimer's disease without concomitant α-synuclein lesions. One patient with clinically diagnosed "progressive supranuclear palsy" had indeterminate pathological findings without α-synuclein or Aβ- or tau-immunoreactive lesions at autopsy. Conclusions: Overall, the clinical diagnoses of parkinsonian subtypes had good concordance with pathological confirmation (86.7%). However, clinical-pathological discrepancies were documented in 13.3%.

Original languageEnglish (US)
JournalMovement Disorders
DOIs
StateAccepted/In press - 2017

Fingerprint

Parkinsonian Disorders
Cohort Studies
Population
Autopsy
Synucleins
Progressive Supranuclear Palsy
Lewy Bodies
Lewy Body Disease
Neurodegenerative Diseases
Blood Vessels
Parkinson Disease
Consensus
Alzheimer Disease
Epidemiology
Guidelines
Incidence
Brain

Keywords

  • Lewy Bodies
  • Parkinsonism
  • Population-based incidence cohort
  • Supranuclear palsy

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

@article{d4670aacd02e417d9ae7c364902f9fe0,
title = "Clinicopathologic discrepancies in a population-based incidence study of parkinsonism in olmsted county: 1991-2010",
abstract = "Objective: The purpose of this study was to examine the discrepancies between the clinical diagnosis of parkinsonism and neuropathological findings in a population-based cohort with parkinsonian disorders. Background: The specific clinical diagnosis of parkinsonism is challenging, and definite confirmation requires neuropathological evaluation. Currently, autopsies are seldom performed, and most brain autopsies represent atypical or diagnostically unresolved cases. Methods: We used a defined population-based incidence cohort with clinical parkinsonism (n=669) from the Rochester Epidemiology Project in Olmsted County, Minnesota, 1991-2010. We reviewed reports of all patients who underwent neuropathologic examination at autopsy (n=60; 9{\%}) and applied consensus pathologic guidelines for neurodegenerative disease diagnosis. Results: Among the 60 patients examined pathologically, the median time from the last recorded clinical diagnosis to death was 7 years (range from 2 to 17 years). Clinical-pathological concordance was found in 52 cases (86.7{\%}), whereas 8 (13.3{\%}) had a clinical-pathological discrepancy. Four patients with a clinical diagnosis of idiopathic Parkinson's disease had no pathological evidence of Lewy bodies or α-synucleinopathy; of these, pathological diagnoses were Alzheimer's disease (2 cases), progressive supranuclear palsy (1 case), and vascular parkinsonism (1 case). Two patients with clinical diagnoses of {"}dementia with Lewy bodies{"} and one patient with an {"}unspecified parkinsonism{"} had a pathological diagnosis of Alzheimer's disease without concomitant α-synuclein lesions. One patient with clinically diagnosed {"}progressive supranuclear palsy{"} had indeterminate pathological findings without α-synuclein or Aβ- or tau-immunoreactive lesions at autopsy. Conclusions: Overall, the clinical diagnoses of parkinsonian subtypes had good concordance with pathological confirmation (86.7{\%}). However, clinical-pathological discrepancies were documented in 13.3{\%}.",
keywords = "Lewy Bodies, Parkinsonism, Population-based incidence cohort, Supranuclear palsy",
author = "Pierpaolo Turcano and Mielke, {Michelle M} and Josephs, {Keith Anthony} and Bower, {James Howard} and Parisi, {Joseph E} and Boeve, {Bradley F} and Rodolfo Savica",
year = "2017",
doi = "10.1002/mds.27125",
language = "English (US)",
journal = "Movement Disorders",
issn = "0885-3185",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Clinicopathologic discrepancies in a population-based incidence study of parkinsonism in olmsted county

T2 - 1991-2010

AU - Turcano, Pierpaolo

AU - Mielke, Michelle M

AU - Josephs, Keith Anthony

AU - Bower, James Howard

AU - Parisi, Joseph E

AU - Boeve, Bradley F

AU - Savica, Rodolfo

PY - 2017

Y1 - 2017

N2 - Objective: The purpose of this study was to examine the discrepancies between the clinical diagnosis of parkinsonism and neuropathological findings in a population-based cohort with parkinsonian disorders. Background: The specific clinical diagnosis of parkinsonism is challenging, and definite confirmation requires neuropathological evaluation. Currently, autopsies are seldom performed, and most brain autopsies represent atypical or diagnostically unresolved cases. Methods: We used a defined population-based incidence cohort with clinical parkinsonism (n=669) from the Rochester Epidemiology Project in Olmsted County, Minnesota, 1991-2010. We reviewed reports of all patients who underwent neuropathologic examination at autopsy (n=60; 9%) and applied consensus pathologic guidelines for neurodegenerative disease diagnosis. Results: Among the 60 patients examined pathologically, the median time from the last recorded clinical diagnosis to death was 7 years (range from 2 to 17 years). Clinical-pathological concordance was found in 52 cases (86.7%), whereas 8 (13.3%) had a clinical-pathological discrepancy. Four patients with a clinical diagnosis of idiopathic Parkinson's disease had no pathological evidence of Lewy bodies or α-synucleinopathy; of these, pathological diagnoses were Alzheimer's disease (2 cases), progressive supranuclear palsy (1 case), and vascular parkinsonism (1 case). Two patients with clinical diagnoses of "dementia with Lewy bodies" and one patient with an "unspecified parkinsonism" had a pathological diagnosis of Alzheimer's disease without concomitant α-synuclein lesions. One patient with clinically diagnosed "progressive supranuclear palsy" had indeterminate pathological findings without α-synuclein or Aβ- or tau-immunoreactive lesions at autopsy. Conclusions: Overall, the clinical diagnoses of parkinsonian subtypes had good concordance with pathological confirmation (86.7%). However, clinical-pathological discrepancies were documented in 13.3%.

AB - Objective: The purpose of this study was to examine the discrepancies between the clinical diagnosis of parkinsonism and neuropathological findings in a population-based cohort with parkinsonian disorders. Background: The specific clinical diagnosis of parkinsonism is challenging, and definite confirmation requires neuropathological evaluation. Currently, autopsies are seldom performed, and most brain autopsies represent atypical or diagnostically unresolved cases. Methods: We used a defined population-based incidence cohort with clinical parkinsonism (n=669) from the Rochester Epidemiology Project in Olmsted County, Minnesota, 1991-2010. We reviewed reports of all patients who underwent neuropathologic examination at autopsy (n=60; 9%) and applied consensus pathologic guidelines for neurodegenerative disease diagnosis. Results: Among the 60 patients examined pathologically, the median time from the last recorded clinical diagnosis to death was 7 years (range from 2 to 17 years). Clinical-pathological concordance was found in 52 cases (86.7%), whereas 8 (13.3%) had a clinical-pathological discrepancy. Four patients with a clinical diagnosis of idiopathic Parkinson's disease had no pathological evidence of Lewy bodies or α-synucleinopathy; of these, pathological diagnoses were Alzheimer's disease (2 cases), progressive supranuclear palsy (1 case), and vascular parkinsonism (1 case). Two patients with clinical diagnoses of "dementia with Lewy bodies" and one patient with an "unspecified parkinsonism" had a pathological diagnosis of Alzheimer's disease without concomitant α-synuclein lesions. One patient with clinically diagnosed "progressive supranuclear palsy" had indeterminate pathological findings without α-synuclein or Aβ- or tau-immunoreactive lesions at autopsy. Conclusions: Overall, the clinical diagnoses of parkinsonian subtypes had good concordance with pathological confirmation (86.7%). However, clinical-pathological discrepancies were documented in 13.3%.

KW - Lewy Bodies

KW - Parkinsonism

KW - Population-based incidence cohort

KW - Supranuclear palsy

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U2 - 10.1002/mds.27125

DO - 10.1002/mds.27125

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JF - Movement Disorders

SN - 0885-3185

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