Low clinical diagnostic accuracy of early vs advanced Parkinson disease: Clinicopathologic study

Charles Howard Adler, Thomas G. Beach, Joseph G. Hentz, Holly A. Shill, John Nathaniel Caviness, Erika M Driver-Dunckley, Marwan N. Sabbagh, Lucia I. Sue, Sandra A. Jacobson, Christine M. Belden, Brittany N. Dugger

Research output: Contribution to journalArticle

190 Citations (Scopus)

Abstract

Objectives: Determine diagnostic accuracy of a clinical diagnosis of Parkinson disease (PD) using neuropathologic diagnosis as the gold standard. Methods: Data from the Arizona Study of Aging and Neurodegenerative Disorders were used to determine the predictive value of a clinical PD diagnosis, using 2 clinical diagnostic confidence levels, PossPD (never treated or not clearly responsive) and ProbPD (responsive to medications). Neuropathologic diagnosis was the gold standard. Results: Based on first visit, 9 of 34 (26%) PossPD cases had neuropathologically confirmed PD while 80 of 97 (82%) ProbPD cases had confirmed PD. PD was confirmed in 8 of 15 (53%) ProbPD cases with <5 years of disease duration and 72 of 82 (88%) with $5 years of disease duration. Using final diagnosis at time of death, 91 of 107 (85%) ProbPD cases had confirmed PD. Clinical variables that improved diagnostic accuracy were medication response, motor fluctuations, dyskinesias, and hyposmia. Conclusions: Using neuropathologic findings of PD as the gold standard, this study establishes the novel findings of only 26% accuracy for a clinical diagnosis of PD in untreated or not clearly responsive subjects, 53%accuracy in early PD responsive to medication (<5 years' duration), and >85% diagnostic accuracy of longer duration, medication-responsive PD. Caution is needed when interpreting clinical studies of PD, especially studies of early disease that do not have autopsy confirmation. The need for a tissue or other diagnostic biomarker is reinforced. Classification of evidence: This study provides Class II evidence that a clinical diagnosis of PD identifies patients who will have pathologically confirmed PD with a sensitivity of 88%and specificity of 68%.

Original languageEnglish (US)
Pages (from-to)406-412
Number of pages7
JournalNeurology
Volume83
Issue number5
DOIs
StatePublished - Jul 29 2014

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Parkinson Disease
Parkinson's Disease
Diagnostic Accuracy
Neurodegenerative Diseases
Autopsy
Biomarkers
Sensitivity and Specificity

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Low clinical diagnostic accuracy of early vs advanced Parkinson disease : Clinicopathologic study. / Adler, Charles Howard; Beach, Thomas G.; Hentz, Joseph G.; Shill, Holly A.; Caviness, John Nathaniel; Driver-Dunckley, Erika M; Sabbagh, Marwan N.; Sue, Lucia I.; Jacobson, Sandra A.; Belden, Christine M.; Dugger, Brittany N.

In: Neurology, Vol. 83, No. 5, 29.07.2014, p. 406-412.

Research output: Contribution to journalArticle

Adler, CH, Beach, TG, Hentz, JG, Shill, HA, Caviness, JN, Driver-Dunckley, EM, Sabbagh, MN, Sue, LI, Jacobson, SA, Belden, CM & Dugger, BN 2014, 'Low clinical diagnostic accuracy of early vs advanced Parkinson disease: Clinicopathologic study', Neurology, vol. 83, no. 5, pp. 406-412. https://doi.org/10.1212/WNL.0000000000000641
Adler, Charles Howard ; Beach, Thomas G. ; Hentz, Joseph G. ; Shill, Holly A. ; Caviness, John Nathaniel ; Driver-Dunckley, Erika M ; Sabbagh, Marwan N. ; Sue, Lucia I. ; Jacobson, Sandra A. ; Belden, Christine M. ; Dugger, Brittany N. / Low clinical diagnostic accuracy of early vs advanced Parkinson disease : Clinicopathologic study. In: Neurology. 2014 ; Vol. 83, No. 5. pp. 406-412.
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abstract = "Objectives: Determine diagnostic accuracy of a clinical diagnosis of Parkinson disease (PD) using neuropathologic diagnosis as the gold standard. Methods: Data from the Arizona Study of Aging and Neurodegenerative Disorders were used to determine the predictive value of a clinical PD diagnosis, using 2 clinical diagnostic confidence levels, PossPD (never treated or not clearly responsive) and ProbPD (responsive to medications). Neuropathologic diagnosis was the gold standard. Results: Based on first visit, 9 of 34 (26{\%}) PossPD cases had neuropathologically confirmed PD while 80 of 97 (82{\%}) ProbPD cases had confirmed PD. PD was confirmed in 8 of 15 (53{\%}) ProbPD cases with <5 years of disease duration and 72 of 82 (88{\%}) with $5 years of disease duration. Using final diagnosis at time of death, 91 of 107 (85{\%}) ProbPD cases had confirmed PD. Clinical variables that improved diagnostic accuracy were medication response, motor fluctuations, dyskinesias, and hyposmia. Conclusions: Using neuropathologic findings of PD as the gold standard, this study establishes the novel findings of only 26{\%} accuracy for a clinical diagnosis of PD in untreated or not clearly responsive subjects, 53{\%}accuracy in early PD responsive to medication (<5 years' duration), and >85{\%} diagnostic accuracy of longer duration, medication-responsive PD. Caution is needed when interpreting clinical studies of PD, especially studies of early disease that do not have autopsy confirmation. The need for a tissue or other diagnostic biomarker is reinforced. Classification of evidence: This study provides Class II evidence that a clinical diagnosis of PD identifies patients who will have pathologically confirmed PD with a sensitivity of 88{\%}and specificity of 68{\%}.",
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AU - Adler, Charles Howard

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AU - Shill, Holly A.

AU - Caviness, John Nathaniel

AU - Driver-Dunckley, Erika M

AU - Sabbagh, Marwan N.

AU - Sue, Lucia I.

AU - Jacobson, Sandra A.

AU - Belden, Christine M.

AU - Dugger, Brittany N.

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N2 - Objectives: Determine diagnostic accuracy of a clinical diagnosis of Parkinson disease (PD) using neuropathologic diagnosis as the gold standard. Methods: Data from the Arizona Study of Aging and Neurodegenerative Disorders were used to determine the predictive value of a clinical PD diagnosis, using 2 clinical diagnostic confidence levels, PossPD (never treated or not clearly responsive) and ProbPD (responsive to medications). Neuropathologic diagnosis was the gold standard. Results: Based on first visit, 9 of 34 (26%) PossPD cases had neuropathologically confirmed PD while 80 of 97 (82%) ProbPD cases had confirmed PD. PD was confirmed in 8 of 15 (53%) ProbPD cases with <5 years of disease duration and 72 of 82 (88%) with $5 years of disease duration. Using final diagnosis at time of death, 91 of 107 (85%) ProbPD cases had confirmed PD. Clinical variables that improved diagnostic accuracy were medication response, motor fluctuations, dyskinesias, and hyposmia. Conclusions: Using neuropathologic findings of PD as the gold standard, this study establishes the novel findings of only 26% accuracy for a clinical diagnosis of PD in untreated or not clearly responsive subjects, 53%accuracy in early PD responsive to medication (<5 years' duration), and >85% diagnostic accuracy of longer duration, medication-responsive PD. Caution is needed when interpreting clinical studies of PD, especially studies of early disease that do not have autopsy confirmation. The need for a tissue or other diagnostic biomarker is reinforced. Classification of evidence: This study provides Class II evidence that a clinical diagnosis of PD identifies patients who will have pathologically confirmed PD with a sensitivity of 88%and specificity of 68%.

AB - Objectives: Determine diagnostic accuracy of a clinical diagnosis of Parkinson disease (PD) using neuropathologic diagnosis as the gold standard. Methods: Data from the Arizona Study of Aging and Neurodegenerative Disorders were used to determine the predictive value of a clinical PD diagnosis, using 2 clinical diagnostic confidence levels, PossPD (never treated or not clearly responsive) and ProbPD (responsive to medications). Neuropathologic diagnosis was the gold standard. Results: Based on first visit, 9 of 34 (26%) PossPD cases had neuropathologically confirmed PD while 80 of 97 (82%) ProbPD cases had confirmed PD. PD was confirmed in 8 of 15 (53%) ProbPD cases with <5 years of disease duration and 72 of 82 (88%) with $5 years of disease duration. Using final diagnosis at time of death, 91 of 107 (85%) ProbPD cases had confirmed PD. Clinical variables that improved diagnostic accuracy were medication response, motor fluctuations, dyskinesias, and hyposmia. Conclusions: Using neuropathologic findings of PD as the gold standard, this study establishes the novel findings of only 26% accuracy for a clinical diagnosis of PD in untreated or not clearly responsive subjects, 53%accuracy in early PD responsive to medication (<5 years' duration), and >85% diagnostic accuracy of longer duration, medication-responsive PD. Caution is needed when interpreting clinical studies of PD, especially studies of early disease that do not have autopsy confirmation. The need for a tissue or other diagnostic biomarker is reinforced. Classification of evidence: This study provides Class II evidence that a clinical diagnosis of PD identifies patients who will have pathologically confirmed PD with a sensitivity of 88%and specificity of 68%.

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