Table 4.

Studies of parkinsonism-specific screening questionnaires tested among samples of undiagnosed PD cases.

Author (Screen)	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*[31]	1994	592 community residents	Additional 2 items that asked about prior PD diagnosis and treatment	Not reported	Exam by unspecified provider	91% - all 100% - diagnosed PD 75% - undiagnosed PD	81%	Not reported	Items related to prior diagnosis and five symptoms (micrographia, soft speech, facial expression, tremor and trouble buttoning) most sensitive
Racette[42]	1999	124 patients with PD, 78 asymptomatic subjects with ≥ 2 family members with PD (53 normal, 25 previously undiagnosed)	Administered by trained interviewer	Definite = [3 of 4 cardinal signs] OR [2 signs + asymmetry and supplemental features]; Probable = [2 of 4 signs] OR [asymmetric onset of 1 sign]; Possible = 1 sign	Exam by neurologist	100% - diagnosed PD 48% - undiagnosed PD 66% - definite cases only	63%	1 (0–9)	Potential bias since subjects aware of family history of PD and may be more aware of symptoms or tend to deny symptoms Examiner was not blinded
Höglinger[44]	2004	1030 adults over 50 who attended clinics of GPs screened, but only 124 of these examined by neurologist	Self-administered; translated to German	[Bradykinesia + at least one of rigidity, rest tremor or postural instability] AND, for PD diagnosis, nigrostriatal denervation by SPECT	Exam by movement-disorder neurologist, and second exam by independent neurologist	92% 100%	84% 97%	3 (0–9) GP clinical impression only	Only subjects who screened positive by questionnaire, GP exam, clinical impression or prior diagnosis from records examined by neurologist (N=74) and additional 50 who screened negative – may falsely elevate SEN
Sarangmath [34]	2005	Part 1: 57 nursing home patients; Part 2: 24 patients with PD and 27 controls	Part 1: Administered by research assistant; Part 2: Administered by neurologist; translated to Kannada (India)	[2 of 4 cardinal signs] OR [1 sign and treatment with PD medications]	Exam by movement disorder neurologist	Part 1: 61–75% Part 2: 100%	25–61% 89%	2 (0–9; with at least one bradykinesia item and one other item positive for Part 1 and 2)	Similar SEN between literate and illiterate population, but SPEC lower among illiterate population; medical experience of interviewer affects performance of screen
Taylor[37]	2006	30 newly diagnosed PD patients from incidence study and 314 subjects from GP practices (72% who screened positive to two items on gait and tremor; 28% who screened negative)	Self-administered (mailed)	2 of 4 cardinal signs	Exam by neurologist	90% 95% [ 83–99]	33% 28% [23–33]	2 (0–9; Tanner screen) 1 (0–2; Modified 2-item screen)	Non-responders to study were older and not all responders gave consent to have confirmatory exam (response bias)
Barbosa[35]	2006	667 community members who screened positive (94% of total positive) and 197 who screened negative (42% of total negative)	Additional item that asked about PD treatment or dopamine blocker use; translated to Portuguese	Bradykinesia + at least one of rest tremor, rigidity or postural instability	Exam by 2 physicians (movement disorder neurologist and geriatrician)	100%	29%	2 (0–9 if untreated) OR 1 (0–9 if on PD medication or dopamine blocker)	Not all participants who completed screening questionnaire were examined (response bias)
Chan, et al [40] screen – 11 parkinsonism specific items
Chan[40]	2000	16 patients with known PD, 40 hospital-based controls and 136 randomly selected community controls	11 items; administered by trained research assistant	2 of 4 cardinal signs	Exam by geriatrician or neurologist	100% 84%	45% - hospital 42% - comm. 86%	1 (0–11) 2 (0–3; reduced screen)	10% of sample had parkinsonism, half of these cases were newly diagnosed (5 with PD and 2 with vascular parkinsonism)
Mutch, et al[36] screen – 8 parkinsonism specific items
Taylor[37]	2006	30 newly diagnosed PD patients from incidence study and 314 subjects from GP practices (72% who screened positive to two items on gait and tremor; 28% who screened negative)	Self-administered (mailed)	2 of 4 cardinal signs	Exam by neurologist	87% 95% [83–99]	28% 28% [23–33]	2 (0–8; Mutch Screen) 1 (0–2; Modified 2-item screen)	Non-responders to study were older and not all responders gave consent to have confirmatory exam (response bias)

Abbreviations: GP – general practitioner; SEN – sensitivity; SPEC – specificity; SPECT – single photon emission computed tomography;

^*abstract presented at national meeting; values in brackets represent 95% confidence interval