Objective: To provide an up-to-date assessment of diagnostic accuracy parameters at early and late stages of the diagnosis in clinical practice and MDS Diagnostic Criteria for Parkinson’s disease (PD) using a large cohort of patients with parkinsonism with post-mortem confirmation.

Background: Diagnosis of PD remains clinical with a suboptimal overall accuracy of 80% in classic clinico-pathological series. Significant advances in the field may have improved diagnostic accuracy in clinical practice. Moreover, MDS Diagnostic Criteria have been published although they have not been validated against neuropathological confirmation. Diagnostic accuracy is essential, not only for adequate clinical care but also for drug development in clinical trials.

Method: Retrospective review of medical records of a large group of consecutive patients with parkinsonism (141 with neuropathological diagnosis of PD : 126 other parkinsonism), from the Queen Square Brain Bank from 2009 to 2019. Clinical diagnosis by the treating clinician was documented at early (within 5 years of motor symptom onset) and final stages. We also retrospectively categorized patients according to the MDS ‘Clinical Diagnostic PD criteria’. Diagnostic accuracy (sensitivity, specificity, positive/negative predictive value) of clinical and diagnostic criteria were compared to the gold standard of neuropathology.

Results: Of 141 patients diagnosed pathologically with PD, 82.3% and 83% were clinically diagnosed as PD at the early and final stages,; 87.9% met the MDS criteria for probable PD. Of 126 non-PD patients, 86.5% and 98.4% were clinically diagnosed as non-PD at the early and final stages; 91.3% and 97.6% were identified as non-PD by the criteria at the early and final stages. The overall accuracy for clinically diagnostic PD were 84.3% and 90.3% at the early and final stages; and the overall accuracy for probable PD using the MDS criteria were 89.5% and 92.5% at the early and final stages.

Conclusion: The MDS diagnostic criteria and clinical diagnosis demonstrated high sensitivity, specificity and overall accuracy at both early and final stages which represent an improvement compared to previous literature.

References: Postuma, Ronald B et al. “MDS clinical diagnostic criteria for Parkinson’s disease.” Movement disorders : official journal of the Movement Disorder Society vol. 30,12 (2015): 1591-601. doi:10.1002/mds.26424

Berg, Daniela et al. “Movement disorder society criteria for clinically established early Parkinson’s disease.” Movement disorders : official journal of the Movement Disorder Society vol. 33,10 (2018): 1643-1646. doi:10.1002/mds.27431

Postuma, Ronald B et al. “Validation of the MDS clinical diagnostic criteria for Parkinson’s disease.” Movement disorders : official journal of the Movement Disorder Society vol. 33,10 (2018): 1601-1608. doi:10.1002/mds.27362

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