Objective: To determine the validity of MDS Diagnostic criteria for PD by assessing individual diagnostic criteria in pathologically confirmed PD

Background: The 2015 MDS criteria were based on expert consensus opinion^1. The original definition of ‘Clinically-Established PD’, based on the Queen Square Brain Bank Criteria¹,², required bradykinesia with at least rest tremor or rigidity, absence of absolute exclusion criteria, 2 of 4 supportive criteria and no ‘red flags’. The 2015 diagnostic criteria for ‘Clinically-Probable PD’ (the anchor for clinical practice) requires no absolute exclusion criteria and a balance between supportive criteria and red flags. Although future PD diagnosis may involve biomarkers, practicing clinicians currently rely on clinical diagnosis. Therefore, examining clinicopathologic correlations for individual criteria may help refine clinical diagnostic criteria

Method: We conducted a literature review for published articles between 1988-2024 using search terms for clinico-pathological series of PD, DLB, and atypical parkinsonian syndromes (APS) MSA, PSP or CBS and sufficient clinical information to assess Supportive criteria, Absolute exclusion criteria or Red flags of MDS clinical PD criteria¹. Articles were reviewed by 2 independent raters and data extracted on the proportion of patients meeting each criterion. Mean percentages and ranges were calculated.

Results: 60 out of 4140 articles met initial inclusion criteria; 32 were excluded for insufficient clinical data, leaving 28 papers. Supportive criteria were reported at higher rates in PD than APS. Objective olfactory loss was uniquely reported in PD, not in APS. Data for absolute exclusion criteria and red flags were often lacking but where available, items were numerically higher in APS than PD. However, some criteria (e.g., downgaze supranuclear palsy; rapid progression to wheelchair; bilateral symmetric parkinsonism and pyramidal tract signs) were identified in > 5% of pathological proven PD cases.

Conclusion: Overall individual items of MDS Clinical diagnostic criteria are more common in pathologically confirmed PD than any APS. However, data is limited by the small number of clinico-pathological studies with sufficient clinical data, challenges in applying highly-specific definitions to retrospective studies and the complexity of co-pathologies. Future diagnostic criteria needs to include pathological correlations with both clinical and ancillary potential biomarkers.

References: 1. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, Obeso J, Marek K, Litvan I, Lang AE, Halliday G, Goetz CG, Gasser T, Dubois B, Chan P, Bloem BR, Adler CH, Deuschl G. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 2015;30:1591-601.
2. Gibb WR, Lees AJ. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J.Neurol Neurosurg Psychiatry 1988;51:745-752.
3. Gibb WR, Lees AJ. The significance of the Lewy body in the diagnosis of idiopathic Parkinson’s disease. Neuropathol Appl Neurobiol. 1989;15(1):27-44.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/critical-appraisal-of-mds-criteria-for-diagnosing-pd/