Report Viewer

NINDS CDE Notice of Copyright
Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's Disease
Availability
Please visit this website for more information about the instrument: Movement Disorder Society Clinical Diagnostic Criteria for Parkinson's Disease
Classification
Supplemental - Highly Recommended: Parkinson's Disease (PD)
Recommendations for use: Indicated for studies assessing PD definition.
Short Description of Instrument
This instrument includes criteria for clinically established PD and clinically probable PD. Exclusion criteria are defined that would suggest an alternate cause of parkinsonism. Red flags are proposed that must be factored in to determine level of certainty in the diagnosis.
Scoring and Psychometric Properties
Scoring: Clinically established PD has parkinsonism (bradykinesia with tremor or rigidity), absence of exclusion criteria, at least 2 supportive criteria and no red flags. Clinically probable PD has parkinsonism, absence of exclusion criteria, red flags balanced by supportive criteria and no more than 2 red flags.
 
Psychometric Properties: Of 434 patients diagnosed with PD, 94.5% met the International Parkinson and Movement Disorder Society criteria for probable PD (5.5% false-negative rate). Of 192 non-PD patients, 88.5% were identified as non-PD by the criteria (11.5% false-positive rate). The overall accuracy for probable PD was 92.6%. In addition, 59.3% of PD patients and only 1.6% of non-PD patients met the International Parkinson and Movement Disorder Society criteria for clinically established PD. The International Parkinson and Movement Disorder Society criteria demonstrated high sensitivity and specificity compared with the gold standard, expert diagnosis, with sensitivity and specificity both higher than United Kingdom Brain Bank criteria (Postuma et al., 2018).
Rationale/Justification
Strengths:
  • Cardinal and absolute exclusion criteria are appropriate

  • Validation study with good sensitivity and specificity (94.5% and 88.5%) compared to UK Brain bank (89.2%, 79.2%) [Postuma, et al., 2018]

  • Bradykinesia is required and defined 

 
Weaknesses:
  • This is really criteria for the diagnosis of Idiopathic PD in the setting of established Parkinsonism (bradykinesia). It does not really help in early stages, differentiating normal from abnormal.

  • Red flags and the requirement that positive red flags can be ignored/counterbalanced by supportive criteria seems somewhat arbitrarily defined

  • Likewise, the definition of a positive ancillary test seems somewhat arbitrary (80% specificity, at least 3 studies of at least 60 participants)

  • Rapid Eye Movement Sleep Behavior Disorder (RBD) was not used as a supportive non-motor feature but could potentially be used in the setting of a non-demented patient without severe dysautonomia

  • Most of supportive criteria requires a trial of dopaminergic therapy

  • [123I]metaiodobenzylguanidine MIBG can be used for supportive criteria but is not widely available (at least in the US)

  • Authors of the criteria study were also the "gold standard" for the validation study. No independent validation yet.

  • Olfactory loss is not really defined (subjective or objective)

  • Dementia not exclusionary (and probably should be). Dementia with Lewy Bodies (DLB) could be called PD. The authors call it the PD dementia with Lewy bodies subtype.

  • No operational definition on how much tremor, rigidity and bradykinesia needs to be present

  • Does not really address the concept of synucleinopathies (IPD, DLB, RBD, MSA, PAF) which might collectively respond to certain treatments 
References
Key Reference:
Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, Obeso J, Marek K, Litvan I, Lang AE, Halliday G, Goetz CG, Gasser T, Dubois B, Chan P, Bloem BR, Adler CH, Deuschl G. MD clinical diagnostic criteria for Parkinson's disease. Mov Disord. 2015 Oct;30(12):1591-1601.
 
Additional Reference:
Postuma RB, Poewe W, Litvan I, Lewis S, Lang AE, Halliday G , Goetz CG, Chan P, Slow E, Seppi K, Schaffer E, Rios-Romenets S, Mi T, Maetzler C, Li Y, Heim B, Bledsoe IO, Berg D. Validation of the MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord. 2018 Oct;33(10):1601-1608.
 
Document last updated August 2022