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Practice Parameter: Diagnosis and prognosis of new onset Parkinson disease (an evidence-based review)

Report of the Quality Standards Subcommittee of the American Academy of Neurology

From the University of Calgary (O.S.), AB, Canada; University of Maryland Hospital (S.R.), Baltimore; Division of Radiation Sciences (J.P.), St. Louis, MO; Movement Disorder Center (T.Z.), Tampa, FL; University of Kansas (G.G.), Kansas City; and University of Maryland School of Medicine (W.J.W.), Baltimore.

Address correspondence and reprint requests to the American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116.

Objective: To define key issues in the diagnosis of Parkinson disease (PD), to define features influencing progression, and to make evidence-based recommendations. Two clinical questions were identified: 1) Which clinical features and diagnostic modalities distinguish PD from other parkinsonian syndromes? 2) Which clinical features predict rate of disease progression?

Methods: Systematic review of the literature was completed. Articles were classified according to a four-tiered level of evidence scheme. Recommendations were based on the evidence.

Results and Conclusions: 1. Early falls, poor response to levodopa, symmetry of motor manifestations, lack of tremor, and early autonomic dysfunction are probably useful in distinguishing other parkinsonian syndromes from Parkinson disease (PD). 2. Levodopa or apomorphine challenge and olfactory testing are probably useful in distinguishing PD from other parkinsonian syndromes. 3. Predictive factors for more rapid motor progression, nursing home placement, and shorter survival time include older age at onset of PD, associated comorbidities, presentation with rigidity and bradykinesia, and decreased dopamine responsiveness. Future research into methods for earlier and more accurate diagnosis of the disease and identification and clarification of predictive factors of rapid disease progression is warranted.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the April 11 issue to find the title link for this article.

Editorial, see page 966

See also pages 976, 983, and 996

This article was previously published in electronic format as an Expedited E-Pub at www.neurology.org.

Quality Standards Subcommittee Members are listed in appendix E-5 on the Neurology Web site at www.neurology.org.

Approved by QSS July 30, 2005; Practice Committee December 15, 2005; Board of Directors February 23, 2006.

Endorsed by the National Parkinson Foundation and the Parkinson’s Disease Foundation.

Disclosures are provided after the text.

Received August 16, 2005. Accepted in final form February 16, 2006.

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