Objective: Review the impact of subspecialty care on diagnosis patterns of patients with parkinsonism at the Jesse Brown VA (JBVA), a VA Consortium center.

Background: The PADRECC (Parkinson’s Disease Research, Education, and Clinical Center) and Consortium Center Network are nationwide centers of excellence for movement disorders care in VA hospitals. Increased subspecialty evaluations may impact patient diagnosis and prognosis.

Methods: Chart review was performed for patients seen at the JBVA Movement Disorders clinic between its initiation in July 2009 through September 2017.

Results: 235 patients with parkinsonism were evaluated upon consultation, 98.7% of whom were male. Average age was 71.3 (SD=9.8), range 30-95. 47.2% were Caucasian, 41.3% African American, and 9.8% Hispanic. Disease duration was 5.51 years (SD=4.9), range 1-30 years. Disagreement with referring diagnosis occurred 46.8% of the time. 69.8% were referred for diagnosis of probable PD, but this was only confirmed in 50.2%. 163 (69.4%) were thought to have probable degenerative parkinsonism disorders. Most frequent non-probable PD diagnoses were possible PD/multifactorial disease (17.4%), progressive supranuclear palsy (7.7%), drug-induced parkinsonism (6.4%), dementia with Lewy bodies (5.5%), vascular parkinsonism (3.8%) and multiple system atrophy (3.4%). The frequency of atypical parkinsonism in degenerative cases was 45/163 (27.6%). Change in diagnostic disease category to a more severe disorder occurred in 15.3%, a more unclear diagnosis in 12.8%, and a less severe disorder in 11.1%.

Conclusions: Using the standards of current diagnostic guidelines, subspecialist care led to revision of referral diagnosis in nearly half of cases. The diagnosis of probable Parkinson’s disease was frequently revised, more often to a more severe disorder or unclear diagnosis of possible PD. Atypical parkinsonism accounted for a significant number of referrals, possibly by referral bias of more severe cases. More accurate diagnosis sets the stage for better treatment options and prognostic counseling, justifying the need for subspecialty expertise in the VA system.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/diagnostic-impact-of-movement-disorders-subspecialty-consultations-at-a-va-hospital/