Parkinson disease

Movement Disorder Society clinical diagnostic criteria for Parkinson's disease[1]Postuma RB, Berg D, Stern M, et al. MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord. 2015 Oct;30(12):1591-601. http://www.ncbi.nlm.nih.gov/pubmed/26474316?tool=bestpractice.com [69]Postuma RB, Poewe W, Litvan I, et al. Validation of the MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord. 2018 Oct;33(10):1601-8. http://www.ncbi.nlm.nih.gov/pubmed/30145797?tool=bestpractice.com

The 2015 Movement Disorder Society (MDS) diagnostic criteria for PD define "parkinsonism" as the presence of bradykinesia with at least one of rest tremor or rigidity.

Once parkinsonism is diagnosed, supportive criteria for idiopathic PD are: a clear response to dopaminergic therapy, and/or the presence of levodopa-induced dyskinesias; rest tremor of a limb; and positive results from at least one ancillary diagnostic test having a specificity greater than 80% for differential diagnosis of PD from other parkinsonian conditions.

Exclusion criteria for idiopathic PD include: cerebellar abnormalities; gaze palsy; dementia early in the disease course; parkinsonism restricted to the lower limbs for more than 3 years; treatment with a dopamine-receptor blocking agent (drug-induced parkinsonism); absence of response to high-dose levodopa; cortical sensory loss, apraxia, or aphasia; and normal functional neuroimaging of the presynaptic dopaminergic system.

Revised Unified Parkinson's Disease Rating Scale (MDS-UPDRS)[96]Goetz CG, Tilley BC, Shaftman SR, et al; Movement Disorder Society UPDRS Revision Task Force. Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord. 2008 Nov 15;23(15):2129-70. https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.22340 http://www.ncbi.nlm.nih.gov/pubmed/19025984?tool=bestpractice.com

Four-part multimodular rating scale system revised to capture more nonmotor features of PD and shift scale from mild/moderate/severe/marked to slight/mild/moderate/severe (to allow more clinically relevant distinctions in earlier disease).

• Part I = nonmotor experiences of daily living (13 items)

• Part II = motor experiences of daily living (13 items)

• Part III = motor examination (33 scores based on 18 items, several with right, left, etc.)

• Part IV = motor complications (6 items).

UK PD Society Brain Bank criteria (UKPDSBB) for diagnosis of probable Parkinson's disease[97]Hughes AJ, Daniel SE, Kilford L, et al. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):181-4. https://jnnp.bmj.com/content/jnnp/55/3/181.full.pdf http://www.ncbi.nlm.nih.gov/pubmed/1564476?tool=bestpractice.com

Inclusion criteria.

1. Bradykinesia (slowness of initiation of voluntary movement with progressive reduction in speed and amplitude of repetitive actions); and at least one of the following:

• Muscular rigidity

• 4-6 Hz rest tremor

• Postural instability not caused by visual, vestibular, cerebellar, or proprioceptive dysfunction.

2. Exclude other causes of parkinsonism.

3. At least three of the following supportive (prospective) criteria:

• Unilateral onset

• Rest tremor present

• Progressive disorder

• Persistent asymmetry affecting side of onset most

• Excellent response (70% to 100%) to levodopa

• Severe levodopa-induced chorea

• Levodopa response for 5 years or more

• Clinical course of 10 years or more.