Objective: To develop a structured clinical acrostic for the differential diagnosis of atypical Parkinsonian syndromes.

Background: The diagnosis of atypical parkinsonian syndromes (APS), including dementia with Lewy bodies (DLB), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), presents a significant challenge, particularly in the early stages, because all of them exhibit overlapping clinical parkinsonian features which are also characteristic of Parkinson’s disease (PD). While additional distinguishing signs are crucial for accurate differential diagnosis, they appear at different disease stages and across multiple systems, making them difficult to recognize and systematically evaluate; this complexity often delays timely and accurate diagnosis. This study proposes a new clinical acrostic designed to provide a structured and easily memorable version of  key signs and symptoms that facilitate the differential diagnosis of atypical parkinsonism.

Method: A systematic review of existing clinical diagnostic criteria was conducted, including the major guidelines and consensus criteria for MCI, MSA, PSP, and CBD. Data extraction focused on key clinical features, and based on this, a clinically relevant acrostic  was developed, that  incorporates most distinctive signs and symptoms of APS that represent a red flag for the diagnosis of PD (Table 1)

Results: The main diagnostic guidelines and consensus for APS were reviewed (1-4),  the most significant signs and symptoms were selected and organized according to their acronyms in the atypical acrostic, so they are easy to remember.(Table 1)

Conclusion: A structured and easily memorable clinical acrostic for APS may help overcome diagnostic challenges by facilitating systematic  assessment  of key differentiating features in routine practice. The  validity and utility of the acrostic  will be assessed through expert consensus and retrospective chart review of patients diagnosed with APS and PD in  movement disorders clinics in Colombia and Argentina.

Table 1. Acrostic for differential diagnosis APS

References: 1. Wenning GK, Stankovic I, Vignatelli L, et al. The Movement Disorder Society criteria for the diagnosis of multiple system atrophy. Mov Disord 2022; 37: 1131–48.
2. McKeith IG, Boeve BF, Dickson DW, Halliday G, Taylor JP, Weintraub D, Aarsland D, Galvin J, Attems J, Ballard CG, Bayston A, Beach TG, Blanc F, Bohnen N, Bonanni L, Bras J, Brundin P, Burn D, Chen-Plotkin A, Duda JE, El-Agnaf O, Feldman H, Ferman TJ, Ffytche D, Fujishiro H, Galasko D, Goldman JG, Gomperts SN, Graff-Radford NR, Honig LS, Iranzo A, Kantarci K, Kaufer D, Kukull W, Lee VMY, Leverenz JB, Lewis S, Lippa C, Lunde A, Masellis M, Masliah E, McLean P, Mollenhauer B, Montine TJ, Moreno E, Mori E, Murray M, O’Brien JT, Orimo S, Postuma RB, Ramaswamy S, Ross OA, Salmon DP, Singleton A, Taylor A, Thomas A, Tiraboschi P, Toledo JB, Trojanowski JQ, Tsuang D, Walker Z, Yamada M, Kosaka K. Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium. Neurology. 2017 Jul 4;89(1):88-100. doi: 10.1212/WNL.0000000000004058.
3. Höglinger GU, Respondek G, Stamelou M, Kurz C, Josephs KA, Lang AE, Mollenhauer B, Müller U, Nilsson C, Whitwell JL, Arzberger T, Englund E, Gelpi E, Giese A, Irwin DJ, Meissner WG, Pantelyat A, Rajput A, van Swieten JC, Troakes C, Antonini A, Bhatia KP, Bordelon Y, Compta Y, Corvol JC, Colosimo C, Dickson DW, Dodel R, Ferguson L, Grossman M, Kassubek J, Krismer F, Levin J, Lorenzl S, Morris HR, Nestor P, Oertel WH, Poewe W, Rabinovici G, Rowe JB, Schellenberg GD, Seppi K, van Eimeren T, Wenning GK, Boxer AL, Golbe LI, Litvan I; Movement Disorder Society-endorsed PSP Study Group. Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria. Mov Disord. 2017 Jun;32(6):853-864. doi: 10.1002/mds.26987. Epub 2017 May 3. PMID: 28467028; PMCID: PMC5516529.
4. Armstrong MJ, Litvan I, Lang AE, Bak TH, Bhatia KP, Borroni B, Boxer AL, Dickson DW, Grossman M, Hallett M, Josephs KA, Kertesz A, Lee SE, Miller BL, Reich SG, Riley DE, Tolosa E, Tröster AI, Vidailhet M, Weiner WJ. Criteria for the diagnosis of corticobasal degeneration. Neurology. 2013 Jan 29;80(5):496-503. doi: 10.1212/WNL.0b013e31827f0fd1. PMID: 23359374; PMCID: PMC3590050.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/enhancing-the-differential-diagnosis-of-atypical-parkinsonian-syndromes-through-a-structured-clinical-acrostic/