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Saturday, May 6, 2017

Early Parkinson's disease: over 90% of patients meet new MDS criteria

Clinical Essentials from Parkinsonism Related Disorders
CURATED BY Susan London

  • More than 90% of patients given a clinical diagnosis of early Parkinson's disease (PD) meet the new Movement Disorder Society (MDS) diagnostic criteria.
Why this matters
  • The new MDS criteria have not been tested prospectively.
Key results 
  • 91.7% of the patients met MDS criteria for PD (63.1% clinically established; 28.7% clinically probable).
  • Relative to clinically probable cases, clinically established cases more often had limb rest tremor (89.3% vs 60.6%), a good L-dopa response (79.5% vs 44.4%), and olfactory loss (71.1% vs 34.5%).
  • Differences between the clinically probable group and the group not meeting MDS criteria were smaller.
  • After 30 mo, most patients initially meeting clinically established or probable criteria still met 1 of these categories (89.5% and 86.9%, respectively).
  • Patients not meeting the MDS criteria had more severe parkinsonism, especially postural instability, gait problems, and cognitive impairment.
Study design
  • A UK cohort study of 2000 patients given a PD diagnosis in the preceding 3.5 y in a multicenter prospective study.
  • Main outcome was fulfillment of MDS diagnostic criteria.
  • Funding: Parkinson’s UK.

  • The MDS criteria were applied retrospectively.
  • L-dopa responsiveness was based on usual morning dose.
  • Data were lacking on some confounders, such as recurrent falls.
Malek N, Lawton MA, Grosset KA, Bajaj N, Barker RA, Ben-Shlomo Y, Burn DJ, Foltynie T, Hardy J, Morris HR, Williams NM, Wood N, Grosset DG. Utility of the new Movement Disorder Society clinical diagnostic criteria for Parkinson's disease applied retrospectively in a large cohort study of recent onset cases. Parkinsonism Relat Disord. 2017 Apr 12 [Epub ahead of print]. doi: 10.1016/j.parkreldis.2017.04.006. PMID: 28431829


Abstract from


To examine the utility of the new Movement Disorder Society (MDS) diagnostic criteria in a large cohort of Parkinson's disease (PD) patients.


Recently diagnosed (<3.5 years) PD cases fulfilling United Kingdom (UK) brain bank criteria in Tracking Parkinson's, a UK multicenter prospective natural history study were assessed by retrospective application of the MDS criteria.


In 2000 cases, 1835 (91.7%) met MDS criteria for PD, either clinically established (n = 1261, 63.1%) or clinically probable (n = 574, 28.7%), leaving 165 (8.3%) not fulfilling criteria. Clinically established cases were significantly more likely to have limb rest tremor (89.3%), a good l-dopa response (79.5%), and olfactory loss (71.1%), than clinically probable cases (60.6%, 44.4%, and 34.5% respectively), but differences between probable PD and 'not PD' cases were less evident. In cases not fulfilling criteria, the mean MDS UPDRS3 score (25.1, SD 13.2) was significantly higher than in probable PD (22.3, SD 12.7, p = 0.016) but not established PD (22.9, SD 12.0, p = 0.066). The l-dopa equivalent daily dose of 341 mg (SD 261) in non-PD cases was significantly higher than in probable PD (250 mg, SD 214, p < 0.001) and established PD (308 mg, SD 199, p = 0.025). After 30 months' follow-up, 89.5% of clinically established cases at baseline remained as PD (established/probable), and 86.9% of those categorized as clinically probable at baseline remained as PD (established/probable). Cases not fulfilling PD criteria had more severe parkinsonism, in particular relating to postural instability, gait problems, and cognitive impairment.


Over 90% of cases clinically diagnosed as early PD fulfilled the MDS criteria for PD. Those not fulfilling criteria may have an atypical parkinsonian disorder or secondary parkinsonism that is not correctly identified by the UK Brain Bank criteria, but possibly by the new criteria.



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