Movement disorder society criteria for clinically established early Parkinson's disease

Daniela Berg, Charles H. Adler, Bastiaan R. Bloem, Piu Chan, Thomas Gasser, Christopher G. Goetz, Glenda Halliday, Anthony E. Lang, Simon Lewis, Yuan Li, Inga Liepelt‐Scarfone, Irene Litvan, Kenneth Marek, Corina Maetzler, Taomian Mi, José Obeso, Wolfgang Oertel, C. Warren Olanow, Werner Poewe, Silvia Rios‐Romenets, Eva Schäffer, Klaus Seppi, Beatrice Heim, Elizabeth Slow, Matthew Stern, Ian O. Bledsoe, Günther Deuschl, Ronald B. Postuma

In 2015, the International Parkinson and Movement Disorder Society published clinical diagnostic criteria for Parkinson's disease (PD). Although recent validation studies suggest high accuracy, one unmet need is for highly specific criteria for clinical trials in early/de novo PD. The objective of this study was to generate and test a PD diagnostic criteria termed "clinically established early PD." We modified the Movement Disorder Society criteria to increase specificity for early PD by removing all disease duration components and changing red flags to absolute exclusions. We then estimated the sensitivity/specificity of clinically established early PD criteria in patients with disease duration <5 years, selected from a 626-patient validation study. After documentation of parkinsonism, 18 individual exclusion criteria are assessed that preclude the diagnosis of "clinically established early PD." Among 212 PD and 152 non-PD patients, the estimated specificity was 95.4%, with 69.8% sensitivity. We describe high-specificity criteria for de novo PD, which are freely available for use in clinical trials. © 2018 International Parkinson and Movement Disorder Society.