Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada.
Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
Mov Disord. 2018 Oct;33(10):1601-1608. doi: 10.1002/mds.27362. Epub 2018 Aug 25.
In 2015, the International Parkinson and Movement Disorder Society published clinical diagnostic criteria for Parkinson's disease. These criteria aimed to codify/reproduce the expert clinical diagnostic process and to help standardize diagnosis in research and clinical settings. Their accuracy compared with expert clinical diagnosis has not been tested. The objectives of this study were to validate the International Parkinson and Movement Disorder Society diagnostic criteria against a gold standard of expert clinical diagnosis, and to compare concordance/accuracy of the International Parkinson and Movement Disorder Society criteria to 1988 United Kingdom Brain Bank criteria.
From 8 centers, we recruited 626 parkinsonism patients (434 PD, 192 non-PD). An expert neurologist diagnosed each patient as having PD or non-PD, regardless of International Parkinson and Movement Disorder Society criteria (gold standard, clinical diagnosis). Then a second neurologist evaluated the presence/absence of each individual item from the International Parkinson and Movement Disorder Society criteria. The overall accuracy/concordance rate, sensitivity, and specificity of the International Parkinson and Movement Disorder Society criteria compared with the expert gold standard were calculated.
Of 434 patients diagnosed with PD, 94.5% met the International Parkinson and Movement Disorder Society criteria for probable PD (5.5% false-negative rate). Of 192 non-PD patients, 88.5% were identified as non-PD by the criteria (11.5% false-positive rate). The overall accuracy for probable PD was 92.6%. In addition, 59.3% of PD patients and only 1.6% of non-PD patients met the International Parkinson and Movement Disorder Society criteria for clinically established PD. In comparison, United Kingdom Brain Bank criteria had lower sensitivity (89.2%, P = 0.008), specificity (79.2%, P = 0.018), and overall accuracy (86.4%, P < 0.001). Diagnostic accuracy did not differ according to age or sex. Specificity improved as disease duration increased.
The International Parkinson and Movement Disorder Society criteria demonstrated high sensitivity and specificity compared with the gold standard, expert diagnosis, with sensitivity and specificity both higher than United Kingdom Brain Bank criteria. © 2018 International Parkinson and Movement Disorder Society.
2015 年，国际帕金森病和运动障碍协会发布了帕金森病的临床诊断标准。这些标准旨在编纂/再现专家临床诊断过程，并帮助在研究和临床环境中标准化诊断。它们与专家临床诊断的准确性尚未得到验证。本研究的目的是验证国际帕金森病和运动障碍协会的诊断标准是否符合专家临床诊断的金标准，并比较国际帕金森病和运动障碍协会标准与 1988 年英国脑库标准的一致性/准确性。
我们从 8 个中心招募了 626 名帕金森病患者（434 名 PD，192 名非 PD）。一位专家神经病学家根据国际帕金森病和运动障碍协会标准（金标准，临床诊断）对每位患者进行 PD 或非 PD 的诊断。然后，第二位神经病学家评估了国际帕金森病和运动障碍协会标准中每个项目的存在/缺失情况。计算了国际帕金森病和运动障碍协会标准与专家金标准相比的总体准确性/一致性率、敏感性和特异性。
在 434 名被诊断为 PD 的患者中，94.5%符合国际帕金森病和运动障碍协会标准的可能 PD（5.5%的假阴性率）。在 192 名非 PD 患者中，88.5%的患者通过该标准被诊断为非 PD（11.5%的假阳性率）。可能 PD 的总体准确性为 92.6%。此外，59.3%的 PD 患者和仅 1.6%的非 PD 患者符合国际帕金森病和运动障碍协会标准的临床确诊 PD。相比之下，英国脑库标准的敏感性较低（89.2%，P=0.008），特异性较低（79.2%，P=0.018），总体准确性较低（86.4%，P<0.001）。诊断准确性不因年龄或性别而异。随着疾病持续时间的增加，特异性提高。
与金标准（专家诊断）相比，国际帕金森病和运动障碍协会标准具有较高的敏感性和特异性，敏感性和特异性均高于英国脑库标准。© 2018 国际帕金森病和运动障碍协会。
