Skip to main content
SpringerLink
Log in

Different diagnostic criteria for Parkinson disease: what are the pitfalls?

  • Neurology and Preclinical Neurological Studies - Review Article
  • Published:
Journal of Neural Transmission Aims and scope Submit manuscript

Abstract

As there are no definite diagnostic tests or reliable biomarkers for Parkinson disease (PD), its diagnosis still relies on the presence of a combination of cardinal motor features, along with the exclusion of other causes of Parkinsonism and the presence of some of supportive features. To date, several diagnostic criteria have been developed for different purposes through expert opinions or comprehensive review of the literature. However, none of them are without limitations. In this article, we review different diagnostic criteria for PD which have been published in the English medical literature, highlighting specific limitations and pitfalls. With considerable progress in the understanding of PD, particularly in a view of diverse clinical symptomatology and its evolution, it will be difficult to establish a single criterion that is capable of capturing all cases at different disease stages. Rather, we should aim to develop a set of criteria which include a consensus on clinical gold standard or reliable biomarkers at different levels of diagnostic certainty for different purposes. Despite a more refined set of criteria that may aid in the recognition of PD, the accuracy of its diagnosis still largely depends on the observational skills and clinical sensitivity of the treating physician.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Bhidayasiri R, Truong DD (2012) Therapeutic strategies for nonmotor symptoms in early Parkinson’s disease: the case for a higher priority and stronger evidence. Parkinsonism Relat Disord 18(Suppl 1):S110–S113

    Article  PubMed  Google Scholar 

  • Bhidayasiri R, Saksornchai K, Kaewwilai L, Phanthumchinda K (2011a) A census of movement disorders at a Thai university hospital. J Neurol Sci 301(1–2):31–34

    Article  PubMed  Google Scholar 

  • Bhidayasiri R, Wannachai N, Limpabandhu S, Choeytim S, Suchonwanich Y, Tananyakul S et al (2011b) A national registry to determine the distribution and prevalence of Parkinson’s disease in Thailand: implications of urbanization and pesticides as risk factors for Parkinson’s disease. Neuroepidemiology 37(3–4):222–230

    Article  PubMed  Google Scholar 

  • Brooks DJ (2012) Parkinson’s disease: diagnosis. Parkinsonism Relat Disord 18(Suppl 1):S31–S33

    Article  PubMed  Google Scholar 

  • Busse K, Heilmann R, Kleinschmidt S, Abu-Mugheisib M, Hoppner J, Wunderlich C et al (2012) Value of combined midbrain sonography, olfactory and motor function assessment in the differential diagnosis of early Parkinson’s disease. J Neurol Neurosurg Psychiatry 83(4):441–447

    Article  PubMed  Google Scholar 

  • Calne DB, Snow BJ, Lee C (1992) Criteria for diagnosing Parkinson’s disease. Ann Neurol 32(Suppl):S125–S127

    Article  PubMed  Google Scholar 

  • Coelho M, Ferreira JJ (2012) Late-stage Parkinson disease. Nat Rev Neurol 8(8):435–442

    PubMed  CAS  Google Scholar 

  • de Rijk MC, Rocca WA, Anderson DW, Melcon MO, Breteler MM, Maraganore DM (1997) A population perspective on diagnostic criteria for Parkinson’s disease. Neurology 48(5):1277–1281

    Article  PubMed  Google Scholar 

  • Dotchin C, Walker R (2012) The management of Parkinson’s disease in sub-Saharan Africa. Expert Rev Neurother 12(6):661–666

    Article  PubMed  CAS  Google Scholar 

  • Fahn S (2011) Classification of movement disorders. Mov Disord 26(6):947–957

    Article  PubMed  Google Scholar 

  • Fahn S, Jankovic J, Hallett M (2011) Parkinsonism: clinical features and differential diagnosis. In: Fahn S, Jankovic J, Hallett M (eds) Principles and practice of movement disorders. Saunders, USA, pp 66–92

    Chapter  Google Scholar 

  • Forno LS (1987) The Lewy body in Parkinson’s disease. Adv Neurol 45:35–43

    PubMed  CAS  Google Scholar 

  • Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson disease. Arch Neurol 56(1):33–39

    Article  PubMed  CAS  Google Scholar 

  • Gibb WR, Lees AJ (1988) The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson’s disease. J Neurol Neurosurg Psychiatry 51(6):745–752

    Article  PubMed  CAS  Google Scholar 

  • Han M, Nagele E, DeMarshall C, Acharya N, Nagele R (2012) Diagnosis of Parkinson’s disease based on disease-specific autoantibody profiles in human sera. PLoS ONE 7(2):e32383

    Article  PubMed  CAS  Google Scholar 

  • Hely MA, Reid WG, Adena MA, Halliday GM, Morris JG (2008) The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Mov Disord 23(6):837–844

    Article  PubMed  Google Scholar 

  • Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17(5):427–442

    Article  PubMed  CAS  Google Scholar 

  • Hughes AJ, Ben-Shlomo Y, Daniel SE, Lees AJ (1992a) What features improve the accuracy of clinical diagnosis in Parkinson’s disease: a clinicopathologic study. Neurology 42(6):1142–1146

    Article  PubMed  CAS  Google Scholar 

  • Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992b) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinic-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184

    Article  PubMed  CAS  Google Scholar 

  • Hughes AJ, Daniel SE, Blankson S, Lees AJ (1993a) A clinicopathologic study of 100 cases of Parkinson’s disease. Arch Neurol 50(2):140–148

    Article  PubMed  CAS  Google Scholar 

  • Hughes AJ, Daniel SE, Lees AJ (1993b) The clinical features of Parkinson’s disease in 100 histologically proven cases. Adv Neurol 60:595–599

    PubMed  CAS  Google Scholar 

  • Hughes AJ, Daniel SE, Lees AJ (2001) Improved accuracy of clinical diagnosis of Lewy body Parkinson’s disease. Neurology 57:1497–1499

    Article  PubMed  CAS  Google Scholar 

  • Hughes AJ, Daniel SE, Ben Shlomo Y, Lees AJ (2002) The accuracy of diagnosis pf parkinsonian syndromes in a specialist movement disorder service. Brain 125:861–870

    Article  PubMed  Google Scholar 

  • Koller WC (1992) How accurately can Parkinson’s disease be diagnosed? Neurology 42(1 Suppl 1):6–16 (discussion 57–60)

    PubMed  CAS  Google Scholar 

  • Larsen JP, Dupont E, Tandberg E (1994) Clinical diagnosis of Parkinson’s disease. Proposal of diagnostic subgroups classified at different levels of confidence. Acta Neurol Scand 89(4):242–251

    Article  PubMed  CAS  Google Scholar 

  • Louis ED, Klatka LA, Liu Y, Fahn S (1997) Comparison of extrapyramidal features in 31 pathologically confirmed cases of diffuse Lewy body disease and 34 pathologically confirmed cases of Parkinson’s disease. Neurology 48(2):376–380

    Article  PubMed  CAS  Google Scholar 

  • Martin WE, Loewenson RB, Resch JA, Baker AB (1973) Parkinson’s disease. Clinical analysis of 100 patients. Neurology 23(8):783–790

    Article  PubMed  CAS  Google Scholar 

  • Meara J, Bhowmick BK, Hobson P (1999) Accuracy of diagnosis in patients with presumed Parkinson’s disease. Age Ageing 28(2):99–102

    Article  PubMed  CAS  Google Scholar 

  • O’Sullivan SS, Williams DR, Gallagher DA, Massey LA, Silveira-Moriyama L, Lees AJ (2008) Nonmotor symptoms as presenting complaints in Parkinson’s disease: a clinicopathological study. Mov Disord 23(1):101–106

    Article  PubMed  Google Scholar 

  • Ozcift A (2012) SVM feature selection based rotation forest ensemble classifiers to improve computer-aided diagnosis of Parkinson disease. J Med Syst 36(4):2141–2147

    Article  PubMed  Google Scholar 

  • Quinn N (1995) Parkinsonism–recognition and differential diagnosis. BMJ 310(6977):447–452

    Article  PubMed  CAS  Google Scholar 

  • Rajput AH, Rozdilsky B, Ang L (1991a) Occurrence of resting tremor in Parkinson’s disease. Neurology 41(8):1298–1299

    Article  PubMed  CAS  Google Scholar 

  • Rajput AH, Rozdilsky B, Rajput A (1991b) Accuracy of clinical diagnosis in Parkinsonism–a prospective study. Can J Neurol Sci 18(3):275–278

    PubMed  CAS  Google Scholar 

  • Rao G, Fisch L, Srinivasan S, D’Amico F, Okada T, Eaton C et al (2003) Does this patient have Parkinson disease? JAMA 289(3):347–353

    Article  PubMed  Google Scholar 

  • Reichmann H (2010) Clinical criteria for the diagnosis of Parkinson’s disease. Neurodegener Dis 7(5):284–290

    Article  PubMed  Google Scholar 

  • Schrag A, Ben-Shlomo Y, Quinn N (2002) How valid is the clinical diagnosis of Parkinson’s disease in the community? J Neurol Neurosurg Psychiatry 73(5):529–534

    Article  PubMed  CAS  Google Scholar 

  • Shi FD, Jia JP (2011) Neurology and neurologic practice in China. Neurology 77(22):1986–1992

    Article  PubMed  Google Scholar 

  • Siderowf A, Stern MB (2008) Premotor Parkinson’s disease: clinical features, detection, and prospects for treatment. Ann Neurol 64(Suppl 2):S139–S147

    PubMed  Google Scholar 

  • Stern MB, Lang A, Poewe W (2012) Toward a redefinition of Parkinson’s disease. Mov Disord 27(1):54–60

    Article  PubMed  Google Scholar 

  • van de Loo S, Walter U, Behnke S, Hagenah J, Lorenz M, Sitzer M et al (2010) Reproducibility and diagnostic accuracy of substantia nigra sonography for the diagnosis of Parkinson’s disease. J Neurol Neurosurg Psychiatry 81(10):1087–1092

    Article  PubMed  Google Scholar 

  • van Rooden SM, Heiser WJ, Kok JN, Verbaan D, van Hilten JJ, Marinus J (2010) The identification of Parkinson’s disease subtypes using cluster analysis: a systematic review. Mov Disord 25(8):969–978

    Article  PubMed  Google Scholar 

  • van Rooden SM, Colas F, Martinez-Martin P, Visser M, Verbaan D, Marinus J et al (2011) Clinical subtypes of Parkinson’s disease. Mov Disord 26(1):51–58

    Article  PubMed  Google Scholar 

  • Ward CD, Gibb WR (1990) Research diagnostic criteria for Parkinson’s disease. Adv Neurol 53:245–249

    PubMed  CAS  Google Scholar 

Download references

Acknowledgment

The study was supported by the Rachadaphiseksomphot Endowment Fund part of the “Strengthen CU's Researcher’s Project” and research unit grant number GRU 52-026-30-005 of Chulalongkorn University, Bangkok, Thailand.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Chulalongkorn Center of Excellence on Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand

    Roongroj Bhidayasiri

  2. Department of Neurology, Geffen School of Medicine at UCLA, Los Angeles, 90095, USA

    Roongroj Bhidayasiri

  3. Klinik und Poliklinik fur Neurologie, Universitatsklinikum Carl Gustav Carus, Dresden, Germany

    Heinz Reichmann

Authors
  1. Roongroj Bhidayasiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heinz Reichmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roongroj Bhidayasiri.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bhidayasiri, R., Reichmann, H. Different diagnostic criteria for Parkinson disease: what are the pitfalls?. J Neural Transm 120, 619–625 (2013). https://doi.org/10.1007/s00702-013-1007-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00702-013-1007-z

Keywords

Search

Navigation