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NEUROLOGY 1992;42:1142
© 1992 American Academy of Neurology

What features improve the accuracy of clinical diagnosis in Parkinson's disease

A clinicopathologic study

Andrew J. Hughes, FRACP, Yoav Ben-Shlomo, MRCP, Susan E. Daniel, MRCPath and Andrew J. Lees, FRCP

Department of Neurology, The Middlesex Hospital, London, UK.(Drs. Hughes and Lees)
Parkinson's Disease Society Brain Bank, Institute of Neurology, London, UK. (Drs. Hughes, Daniel, and Lees)
Department of Epidemiology and Public Health, University College London, London, UK. (Dr. Ben-Shlomo)

Many authorities have drawn attention to the difficulties in clinically distinguishing Parkinson's disease (PD) from other parkinsonian syndromes. We assessed the clinical features of 100 patients diagnosed prospectively by a group of consultant neurologists as having idiopathic PD according to their pathologic findings. Seventy-six percent of these cases were confirmed to have PD. By using selected criteria (asymmetrical onset, no atypical features, and no possible etiology for another parkinsonian syndrome) the proportion of true PD cases identified was increased to 93%, but 32% of pathologically confirmed cases were rejected on this basis. These observations suggest that studies based on consultant diagnosis of PD, using standard diagnostic criteria, will include cases other than PD, thus distorting results from clinical trials and epidemiologic studies. The strict use of additional criteria can reduce misdiagnosis but at the cost of excluding genuine PD cases.

Address correspondence and reprint requests to Dr. Andrew J. Lees, Department of Neurology, The Middlesex Hospital, Mortimer Street, London WIN 8AA, UK.

Dr. Hughes and Dr. Daniel are funded by the Parkinson's Disease Society, UK. Dr. Ben-Shlomo is a Wellcome research fellow in Clinical Epidemiology.

Received August 9, 1991. Accepted for publication in final form November 5, 1991.




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