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Accuracy of Clinical Diagnosis in Parkinsonism — A Prospective Study

Published online by Cambridge University Press:  18 September 2015

A.H. Rajput ,
B. Rozdilsky  and
Alex Rajput
A.H. Rajput
Affiliation:
Department of Medicine (Neurology) and Department of Pathology (Neuro-pathology), University of Saskatchewan, Saskatoon
B. Rozdilsky
Affiliation:
Department of Medicine (Neurology) and Department of Pathology (Neuro-pathology), University of Saskatchewan, Saskatoon
Alex Rajput*
Affiliation:
Department of Medicine (Neurology) and Department of Pathology (Neuro-pathology), University of Saskatchewan, Saskatoon
*
Department of Medicine, Division of Neurology, Royal University Hospital, Saskatoon, Saskatchewan, Canada S7N 0X0
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Abstract:

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Clinical diagnosis of Parkinson's syndrome (PS) is reasonably easy in most cases but the distinction between different variants of PS may be difficult in early cases. The correct diagnosis is not only important for counselling and management of patients but also in conducting pharmacological and epidemiological studies. There is very little critical literature on the pathological verification of the clinical diagnosis in PS. We report our 22 year experience to address that issue. Between 1968 and 1990, 65 PS patients came to autopsy. Complete data are available in 59 (M- 50, F-19) cases. The initial diagnosis made by a qualified neurologist was idiopathic Parkinson's disease (IPD) in 43 cases. Of those 28 (65%) had Lewy body pathology. After a mean duration of 12 years the final diagnosis was IPD in 41 cases which was confirmed in 31 (76%). The IPD could not be clinically distinguished from cases with severe substantia nigra neuronal loss without inclusions or from those with neurofibrillary tangle inclusions and neuronal loss at the anatomical sites typically involved in IPD. All progressive supra-nuclear palsy, olivopontocerebellar atrophy, Jakob-Creutzfeldt's disease and the majority of the multiple system atrophy cases were diagnosed correctly during life. The correct clinical diagnosis in most non-IPD variants of PS was possible within 5 years of onset (range: 2 months to 18 years). We recommend that studies aimed at including only the IPD cases restrict the enrollment to those cases that have had PS motor manifestations for five years or longer duration.

Information

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 18 , Issue 3 , August 1991 , pp. 275 - 278
Copyright
Copyright © Canadian Neurological Sciences Federation 1991

References

REFERENCES

1.Rajput, AH, Offord, KP, Beard, CM, et al. Epidemiology of parkinsonism: Incidence, classification and mortality. Ann Neurol 2010; 16: 278–282.CrossRefGoogle Scholar
2.Duvoisin, R, Golbe, LI. Toward a definition of Parkinson's disease. Neurology 1989; 39: 746.CrossRefGoogle Scholar
3.The Parkinson Study Group. Effect of Deprenyl on the progression of disability in early Parkinson's disease. N Engl J Med 1989; 321: 1364–1371.CrossRefGoogle Scholar
4.Tetrud, JW, Langston, JW. The effect of Deprenyl (selegiline) on the natural history of Parkinson's disease. Science 1989; 245: 519–522.CrossRefGoogle ScholarPubMed
5.Rajput, AH, Uitti, RJ, Stern, W, et al. Geography, drinking water chemistry, pesticides and herbicides and the etiology of Parkinson's disease. Can J Neurol Sci 1987; 14: 414–418.CrossRefGoogle ScholarPubMed
6.Martint, WRW, Palmer, MR, Patlak, CS, et al. Nigrostriatal function in humans studied with positron emission tomography. Ann Neurol 1989; 26: 535–542.CrossRefGoogle Scholar
7.Wolters, EC, Huang, CC, Clark, C, et al. Positron emission tomography in manganese intoxication. Ann Neurol 1989; 26: 647–651.CrossRefGoogle ScholarPubMed
8.Tedroff, J, Aquilonius, SM, Laihinen, A, et al. Striatal kinetics of [ 11C]-(+)-nomifensine and 6-[l8F]fluoro-L-dopa in Parkinson's disease measured with positron emission tomography. Acta Neurol Scand 1990; 81: 24–30.CrossRefGoogle Scholar
9.Olanow, CW, Drayer, BP, Dawon, D. High-field-strength MR imaging of brain iron in Parkinson's disease. Neurology 1987; 37 (suppl 1): 321–321.Google Scholar
10.Huber, SJ, Shuttleworth, EC, Christy, JA, et al. Magnetic resonance imaging in dementia of Parkinson's disease. J Neurol Neurosurg Psychiatry 1989; 52: 1221–1227.CrossRefGoogle ScholarPubMed
11.Forno, LS, Shuttleworth, EC, Christy, JA, et al. Pathology of parkinsonism: A preliminary report of 24 cases. J Neurosurg 1966; 24: 266–271.Google Scholar
12.Rajput, AH, Uitti, RJ, Rajput Alex, H. et al. Neurological disorders and services in Saskatchewan — a report based on provincial health care recordsNeurological disorders and . Neuroepidemiology 1988; 7: 145–151.CrossRefGoogle ScholarPubMed
13.Rajput, AH, Stern, W, Laverty, WH. Chronic low dose therapy in Parkinson's disease: An argument for delaying levodopa therapy. Neurology 1984; 34(8): 991–996.CrossRefGoogle ScholarPubMed
14.Webster, DD. Critical analysis of disability in Parkinson's disease. Mod Treat 1968; 5: 257–282.Google ScholarPubMed
15.Hoehn, MM, Yahr, MD. Parkinsonism: Onset, progression, and mortality. Neurology 1967; 17: 427–442.CrossRefGoogle ScholarPubMed
16.Rajput, AH, Rozdilsky, RJ, Rajput Alex, H. Parkinson syndrome: Response to levodopa and the underlying pathology. Mov Disord 1990; 5 (suppl 1): 49–49.Google Scholar
17.Rajput, AH, Rozdilsky, B, Rajput Alex, . et al. Levodopa efficacy and pathological basis of Parkinson syndrome. Clin Neuropharmacol 1990; 13, NO. 6:553–558.CrossRefGoogle ScholarPubMed
18.Calne, DB, Langston, JW. Aetiology of Parkinson's disease. Lancet 1983; 2: 1457–1459.CrossRefGoogle ScholarPubMed
19.Calne, DB, McGeer, E, Eisen, A, et al. Alzheimer's disease, Parkinson's disease, and Motorneurone disease: Abiotrophic interaction between ageing and environment. Lancet 1986; 2: 1067–1070.CrossRefGoogle Scholar
20.Bhatt, MH, Snow, BJ, Martin, WRW, et al. Positron emission tomography in Progressive Supranuclear Palsy and Shy Drager syndrome. Mov Disord 1990; 5 (suppl 1): 19–19.Google Scholar
21.Hughes, AJ, Lees, AJ, Stern, GM. Apomorphine test to predict dopaminergic responsiveness in parkinsonian syndromes. Lancet 1990; 336: 32–34.CrossRefGoogle ScholarPubMed
22.Forno, LS, Alvord, EC. The pathology of parkinsonism. In: McDowell, FH, Markham, CH, eds. Recent advances in Parkinson's disease. Philadelphia: FA. Davis Company, 1971: 120–161.Google Scholar
23.Alvord, EC Jr, Forno, LS, Kusske, JA, et al. The pathology of parkinsonism: A comparison of degenerations in cerebral cortex and brainstem. In: McDowell, FH, Barbeau, A, eds. Advances in Neurology Volume 5, New York: Raven Press, 1974: 175–193.Google Scholar
24.Jellinger, K. The pathology of parkinsonism. In: Marsden, CD, Fahn, S, eds. Movement Disorders 2. London: Butterworths and Co., 1987: 124–165.Google Scholar
25.Gibb, WRG, Lees, AJ. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease. J Neurol Neurosurg Psychiatry 1988; 51: 745–752.CrossRefGoogle Scholar
26.Gibb, WRG. Dementia and Parkinson's disease. Brit J Psychiat 1989; 154: 596–614.CrossRefGoogle ScholarPubMed
27.Shy, GM, Drager, GA. A neurological syndrome associated with orthostatic hypotension. Arch Neurol 1960; 2: 511–527.CrossRefGoogle ScholarPubMed
28.Steele, JC, Richardson, JC, Olszewski, J. Progressive supranuclear palsy. Arch Neurol 1964; 10: 333–359.CrossRefGoogle ScholarPubMed
29.Adams, RD, van Bogaert, L, Van der Eecken, H. Striato-nigral degeneration. J Neuropathol Exp Neurol 1964; 23: 584–608.Google ScholarPubMed
30.Rajput, AH, Uitti, RJ, Sudhakar, S, et al. Parkinsonism and neurofibrillary tangle pathology in pigmented nuclei. Ann Neurol 1989; 25: 602–606.CrossRefGoogle ScholarPubMed
31.Davis, GC, Williams, AC, Markey, , et al. Chronic parkinsonism secondary to intravenous injection of meperidine-analog synthesis. Psychiat Res 1979; 1: 249–254.CrossRefGoogle Scholar
32.Lennox, G, Lowe, J, Landon, M, et al. Diffuse lewy body disease: Correlative neuropathology using anti-ubiquitin immunocytochemistry. J Neurol Neurosurg Psychiatry 1989; 52: 1236–1247.CrossRefGoogle ScholarPubMed
33.Steele, JC, Guzman, T, Landon, M, et al. Observations about amyotrophic lateral sclerosis and the parkinson-dementia complex of Guam with regard to epidemiology and etiology. Can J Neurol Sci 1987; 14: 358–362.CrossRefGoogle ScholarPubMed
34.Langston, JW, Ballard, P, Tetrud, JW, et al. Chronic parkinsonism in humans due to a produce of meperidine-analog synthesis. Science 1983; 219: 979–980.CrossRefGoogle Scholar
35.Rajput, AH, Kazi, KH, Rozdilsky, B. Striatonigral degeneration response to levodopa therapy. J Neurol Sci 1972; 16: 331–341.CrossRefGoogle ScholarPubMed
36.Rajput, AH, Rozdilsky, B, Homykiewicz, O, et al. Reversible drug induced parkinsonism. Arch Neurol 1982; 39: 644–646.CrossRefGoogle ScholarPubMed