Accuracy of Clinical Diagnosis in Early Parkinson Disease Accuracy of
Clinical Diagnosis in Early Parkinson Disease
I was interested to read in the conclusion of the abstract of the report
of Jankovic et alHYPERLINK
"http://archneur.ama-assn.org/issues/v58n2/ffull/nlt0201-2.html#rc1r1"1
that "only 65 (8.1%) of 800 patients initially diagnosed as having
Parkinson disease (PD) were later found to have an alternate diagnosis
based on multifactorial clinical criteria." This conclusion ignores the
"gold standard" neuropathological data in the text suggesting the
possibility of a much higher misdiagnosis rate.
Eighteen of the 800 patients had an autopsy, the results of which were
available for 13. Three (23%) had multiple system atrophy of
parkinsonian predominance, 2 (15%) had progressive supranuclear palsy,
and 2 (15%) had other non-PD diagnoses, accounting for 54% of cases with
autopsy results. Two further patients (15%) had a dementia with Lewy
bodies ("1 with PD and Alzheimer disease," 1 with "dementia with the
presence of Lewy bodies"). Although it is not explicitly stated, I
presume the remaining 4 (31%) actually had uncomplicated PD.
While I recognize, as mentioned in the article, that "patients in whom
autopsies were performed were more likely not to have PD," the autopsy
data nevertheless suggest that the misdiagnosis rate among the
participating experts in movement disorders is likely to be considerably
greater than their 8.1% rate of clinical rediagnosis.
Niall Quinn, MD, FRCP
Institute of Neurology
University College London
Queen Square
London, WC1N 3BG
England
HYPERLINK
"http://archneur.ama-assn.org/issues/v58n2/ffull/nlt0201-2.html#rrc1r1"1
. Jankovic J, Rajput AH, McDermott MP, Perl DP, for the Parkinson Study
Group. The evolution of diagnosis in early Parkinson disease. Arch
Neurol. 2000;57:369-372. HYPERLINK
"http://archneur.ama-assn.org/issues/v57n3/abs/noc8665.html"ABSTRACT |
HYPERLINK
"http://archneur.ama-assn.org/issues/v57n3/rfull/noc8665.html"FULL TEXT
| HYPERLINK
"http://archneur.ama-assn.org/issues/v57n3/rpdf/noc8665.pdf"PDF |
HYPERLINK
"http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&
uid=10714663"MEDLINE
HYPERLINK
"http://archneur.ama-assn.org/images/dot_moss_999966.gif"JOC80004
In reply
We are grateful to Dr Quinn for giving us the opportunity to expand on
the differences between our studyHYPERLINK
"http://archneur.ama-assn.org/issues/v58n2/ffull/nlt0201-2.html#rc2r1"1
and the cited clinicopathological reports. As we pointed out in our
report, in contrast to the studies in which the diagnosis was verified
at autopsy, in our study we relied chiefly on multifactorial clinical
criteria. We appropriately acknowledged the limitations of this method
in our article. Our findings are based on the observations of experts
who, by virtue of their experience in diagnosing PD, were selected to
participate in the Deprenyl and Tocopherol Antioxidative Therapy for
Parkinson's Disease (DATATOP) study. We also wish to emphasize that the
reported figure of 8.1% is not a misdiagnosis rate, but rather a
diagnosis modification rate based on our clinical diagnostic criteria.
It is important to emphasize that our study involved patients in early
stages of PD. Patients with rapidly progressive disease leading to death
within a few years after onset of symptoms, which were the cases
included in the autopsy series, would be expected to have a diagnosis
other than PD. It is, therefore, not surprising that the majority of our
autopsied cases did not have PD. We therefore disagree with Dr Quinn's
conclusions based on the autopsy data. While we cannot make definite
statements regarding the actual diagnostic accuracy of the DATATOP
investigators, our study suggests that it is indeed likely to be high.
We hope that this will clarify Dr Quinn's interpretation of our study.
Joseph Jankovic, MD
Parkinson's Disease Center and Movement Disorders Clinic
Baylor College of Medicine
6550 Fannin, Suite 1801
Houston, TX 77030
(e-mail: HYPERLINK "mailto:[log in to unmask]"[log in to unmask])
Ali H. Rajput, MD
Saskatoon, Saskatchewan
Michael McDermott, PhD
Rochester, NY
Daniel Perl, MD
New York, NY
HYPERLINK
"http://archneur.ama-assn.org/issues/v58n2/ffull/nlt0201-2.html#rrc2r1"1
. Jankovic J, Rajput AH, McDermott MP, Perl DP, for the Parkinson Study
Group. The evolution of diagnosis in early Parkinson disease. Arch
Neurol. 2000;57:369-372. HYPERLINK
"http://archneur.ama-assn.org/issues/v57n3/abs/noc8665.html"ABSTRACT |
HYPERLINK
"http://archneur.ama-assn.org/issues/v57n3/rfull/noc8665.html"FULL TEXT
| HYPERLINK
"http://archneur.ama-assn.org/issues/v57n3/rpdf/noc8665.pdf"PDF |
HYPERLINK
"http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&
uid=10714663"MEDLINE
HYPERLINK
"http://archneur.ama-assn.org/images/dot_moss_999966.gif"JOC80004
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