Objective: 1. Assess how accurately clinicians diagnose Advanced Parkinson’s Disease (APD) in a routine clinical setting

2. Evaluate concordance between 5-2-1 criteria and clinician judgement, including the offering of advanced therapies.

Background: 33-38% of people with Parkinsons (PwP) have APD^1,2. APD is associated with increasing symptom burden and dependency^1,3. Early identification is essential for consideration of advanced therapies. The 5-2-1 criteria (≥5 daily levodopa doses, ≥2 hours of OFF time per day, or ≥1 hour of dyskinesia per day) is a screening tool to identify patients with possible advanced disease^1,4,3

Method: Retrospective review of documentation and available Parkinson’s Kinetigraph (PKG) for patients attending Parkinson’s Clinic at University Hospital Llandough, S.Wales, UK from October 2025 to January 2026. Screen patients for APD using 5-2-1 criteria. Review documentation of 5-2-1 positive patients to determine APD, offering of advanced therapies (subcutaneous apomorphine, levodopa-carbidopa intestinal gel, deep brain stimulation), if not, ascertain why.

Results: Of 56 patients reviewed, 27 (48.2%) were found to be 5-2-1 positive, 22 (>5 doses), 3 (>2 hrs off), 9 (>1 hr dyskinesia). Clinicians recognised 66.7% on routine review (documented or initiation of advanced therapies)

6/18 clinician recognised APD patients were offered advanced therapies (1 of whom declined).  2 offered opicapone as bridging therapy to advanced treatments. Of the remaining, 4 were already on advanced therapies, 5 continued on opicapone,1 had ongoing optmisation

Amongst clinician unrecognised 5-2-1 positive patients (9), 6 had treatment changes, 3 were stable or improving.

Overall, 37% of 5-2-1 positive patients and 55.5% clinician recognised APD were offered advanced therapies.

Conclusion: 2/3^rd of 5-2-1 positive cohort were acknowledged as having APD and more than half were offered advanced or bridging therapy (opicapone). There appears to be multiple reasons for non-consideration of advanced therapies in a multi-morbid population.

Our study indicates the 5-2-1 tool may help improve detection of APD.

References: 1. Malaty IA, Martinez-Martin P, Chaudhuri KR, Odin P, Skorvanek M, Jimenez-Shahed J, Soileau MJ, Lindvall S, Domingos J, Jones S, Alobaidi A, Jalundhwala YJ, Kandukuri PL, Onuk K, Bergmann L, Femia S, Lee MY, Wright J, Antonini A. Does the 5-2-1 criteria identify patients with advanced Parkinson’s disease? Real-world screening accuracy and burden of 5-2-1-positive patients in 7 countries. BMC Neurol. 2022 Jan 24;22(1):35.
2. Martínez-Castrillo JC, Martínez-Martín P, Burgos Á, Arroyo G, García N, Luquín MR, Arbelo JM. Prevalence of Advanced Parkinson’s Disease in Patients Treated in the Hospitals of the Spanish National Healthcare System: The PARADISE Study. Brain Sci. 2021 Nov 24;11(12):1557. doi: 10.3390/brainsci11121557.
3. Antonini A, Stoessl AJ, Kleinman LS, Skalicky AM, Marshall TS, Sail KR, Onuk K, Odin PLA. Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson’s disease: a multi-country Delphi-panel approach. Curr Med Res Opin. 2018 Dec;34(12):2063-2073. doi: 10.1080/03007995.2018.1502165
4. Santos-García D, de Deus Fonticoba T, Suárez Castro E, Aneiros Díaz A, McAfee D. 5-2-1 Criteria: A Simple Screening Tool for Identifying Advanced PD Patients Who Need an Optimization of Parkinson’s Treatment. Parkinsons Dis. 2020 Mar 24;2020:7537924. doi: 10.1155/2020/7537924.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/assessing-concordance-between-clinical-judgment-and-5-2-1-criteria-in-advanced-parkinsons-disease/