Objective: To externally validate the Dutch Device-Aided Therapy Screening tool (D-DATS) and to compare it with the 5-2-1 criteria.

Background: Timely identification of patients with Parkinson’s disease (PD) who may be eligible for device-aided therapy (DAT) is important but challenging for general neurologists. To this end several screening tools have been proposed, such as the 5-2-1 criteria, and more recently the easy-to-use D-DATS (Moes et al. 2023). The latter is based on the presence of response fluctuations and troublesome dyskinesias, and the levodopa equivalent daily dose. The 5-2-1 criteria are met if a patient has at least one of the following three clinical indicators: ≥5 doses of oral levodopa per day, OR ≥2 hours of “off” time per day, OR ≥1 hour of troublesome dyskinesia per day. Meanwhile, after rigorous development, the D-DATS is awaiting external validation and comparison with other screening tools.

Method: We performed a multicenter prospective, cross-sectional diagnostic study in DAT-naive PD patients attending a routine visit in a secondary care setting in the northeastern part of the Netherlands. Clinical characteristics of consecutive patients were collected by the attending physician. Anonymized patient vignettes were assessed by a panel of 5 movement disorder experts with expertise in DAT. The outcome (reference test) was eligibility for referral for DAT as assessed by the expert panel. The diagnostic accuracy of the D-DATS and 5-2-1 criteria was compared with the reference test.

Results: The cohort of 250 patients included 32 patients eligible for DAT referral (12.4%). The D-DATS had excellent discrimination in assessing eligibility for DAT referral (ROC AUC = 0.95; 95% CI: 0.91-0.98), while the 5-2-1 criteria had acceptable discrimination (ROC AUC = 0.79; 95% CI: 0.73-0.82). The diagnostic accuracy of the D-DATS (cut-off value 5.8) compared to the 5-2-1 criteria was 81% vs 92% for sensitivity, and 92% vs 59% for specificity respectively. The positive predictive value was 59% for D-DATS and 26% for the 5-2-1 criteria.

Conclusion: The results of this external validation study confirm the validity of the D-DATS in identifying PD patients eligible for referral for DAT. Compared with the 5-2-1 criteria, the D-DATS appears to be slightly less sensitive but more specific, resulting in a superior positive predictive value.

References: Moes, Harmen R., et al. “Timely referral for device-aided therapy in Parkinson’s disease. Development of a screening tool.” Parkinsonism & Related Disorders (2023): 105359.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/validation-of-models-for-assessing-eligibility-for-referral-for-device-aided-treatment-in-parkinsons-disease-validate/