Table 3.
Studies of parkinsonism-specific screening questionnaires tested among sample of only previously diagnosed parkinsonism cases
| Author | Date | Sample | Survey details | Parkinsonism definition | Gold standard | SEN | SPEC | Cut-off value (range) | Comments |
|---|---|---|---|---|---|---|---|---|---|
| Tanner, et al[30] screen – 9 parkinsonism specific items | |||||||||
| Tanner*[30] | 1990 | 178 patients with mix of neurological disorders, 5 with arthritis and 53 normal older adults | Self-administered | Not reported | Exam by movement-disorder neurologist | 91% 84% |
81% 90% |
4 (0–9) 5 (0–9) |
Lower SPEC for patients when only included group with movement disorders (78%) and motor deficits (72%) |
| Duarte[32] | 1995 | 40 patients with known PD and 100 patients from ophthalmology clinic | Self-administered (mailed), translated to Spanish | Not reported | Exam by neurologist | 92% 100% |
95% 100% |
4.4 (0–9) 42 (weighted range 0 – 67) |
Of the PD cases, 5% were stage 1, 28% were stage 2 and 67% were stage 3 or 4. High SEN to detect moderate to advanced disease |
| Rocca[41] | 1998 | 37 patients with PD and 16 unaffected controls | Telephone interview by trained, blinded interviewer | [3 of 4 cardinal signs] OR [2 cardinal signs with neurologist diagnosis of PD and/or response to levodopa] | Review of medical records | 97% 89% |
44% 88% |
2 (0–9) 4 (0–9) |
Proxy could respond for patient including deceased subjects Individual items with highest SEN were poor balance and trouble buttoning; tremor had highest SPEC |
| Pramstaller[33]0000000000 | 1999 | 40 patients with PD or atypical parkinsonism and 36 unaffected controls | Additional 2 items related to prior diagnosis and treatment; translated to German and Italian (mailed) | Bradykinesia + at least 1 of rigidity, rest tremor or postural instability | Exam by movement disorder neurologist | 95% 90% 95% |
89% 94% 90% |
3 (not reported) 4 (not reported) 24 (weighted range 0–67) |
Higher frequency of false positive responses in subjects with depression, osteoporosis and older age Higher frequency of false negative responses in subjects with earlier stages, tremor as main or only symptom and younger age |
| Tan*[43] | 2002 | 20 patients with PD, 33 with stroke/TIA, 13 with epilepsy and 31 from general neurology | Additional item that asked about previous diagnosis of PD; administered by trained interviewer | Not reported | Exam by neurologist | 100% 85% |
37% 77% |
1 (0–9) 3 (0–9) |
Low specificity in sample with neurological co-morbidity Not specified if screen was translated (81 subjects Chinese, 9 Indian and 7 Malay in Singapore) |
| Mutch, et al[36] screen – 8 parkinsonism specific items | |||||||||
| Mutch[36] | 1991 | 35 patients with known PD and 88 controls from general practice | Self-administered | 2 of 4 cardinal signs | Exam | 91% 97% |
92% 66% |
1 (0–2; tremor + shuffling gait) 1 (0–8; full screen) |
Only controls who screened positive were examined, but if the exam confirmed parkinsonism they were not included as true positives |
| Meneghini, et al (modified WHO) screen[21] – 2 parkinsonism specific items, 7 general neurology items and 7 physical tasks | |||||||||
| Meneghini[21] (modified WHO) | 1992 | 21 patients with known parkinsonism, 66 with mix of other neurologic disease and 21 controls | Administered by neurologist | [2 of 4 cardinal signs if not on PD therapy] OR [1 of 4 cardinal signs if on PD therapy] | Exam by senior neurologist | 100% 95% |
86% 100% |
1 (0–16) 1 (0–7) |
Included idiopathic PD, drug-induced, vascular, postencephalitic and atypical parkinsonism cases Measurement of specificity was with group completely free of disease |
| Bergareche[22] (modified WHO) | 2004 | 6 patients with known PD, 91 controls | Administered by trained interviewer | [2 of 4 cardinal signs] OR [1 of 4 signs if on PD treatment] | Not reported | 100% [51.7–100] | 25.8% [17.7–36.6] | Not reported | Medical and neurological co-morbidities of control population not reported |
| Nicoletti, et al[38] screen -- 4 parkinsonism specific items and 5 physical tasks | |||||||||
| Nicoletti[38] | 2004 | 40 patients with known PD (20 stage 1–2; 20 stage 3–5), 20 with ET and 20 controls | Administered by trained interviewer | [2 of 4 cardinal signs] OR [1 of 4 signs if on PD treatment] | Not reported | 100% [80–100] | 90% [67–98] | 1 (0–9) | Controls completely free of disease |
| Ishihara, et al[39] screen – 6 parkinsonism specific items | |||||||||
| Ishihara[39] | 2005 | 18,645 (subcohort of larger community-based study); 11,539 answered all screen items | Self-administered | Not reported | Self-reported PD, administrative record review (hospital discharge and death certificates) | 96% 91% |
56% 76% |
1 (0–6) 1 (0–5; exclusion of gait item) |
Physical examinations of cases/controls not conducted to verify PD diagnosis Could not ascertain previously undiagnosed PD |
Abbreviations: ET – essential tremor; SEN – sensitivity; SPEC – specificity; WHO – World Health Organization;
*
abstract presented at national/international meeting; values in brackets represent 95% confidence interval