A brand new examine by the College of Turku and Turku College Hospital, Finland, discovered {that a} important proportion of Parkinson’s illness diagnoses are later corrected. As much as one in six diagnoses modified after ten years of follow-up, and the vast majority of new diagnoses have been made inside two years of the unique prognosis.
A latest examine printed in Neurology reveals important diagnostic instability in Parkinson’s illness, with 13.3% of diagnoses revised over a 10-year follow-up interval. When dementia with Lewy our bodies (DLB) is handled as a separate diagnostic class, the revision price will increase to 17.7%.
The massive-scale examine adopted over 1,600 sufferers initially identified with Parkinson’s illness. The outcomes display the continuing problem of distinguishing it from different related issues, regardless of enhancements in diagnostics.
“Notably, a majority of those diagnostic modifications happen throughout the first two years of prognosis, which emphasises the challenges and uncertainty clinicians face in diagnosing Parkinson’s illness precisely,” explains Valtteri Kaasinen, Professor of Neurology on the College of Turku and principal investigator of the examine.
Medical practices and diagnostic challenges improve misdiagnoses
Generally revised diagnoses included vascular parkinsonism, progressive supranuclear palsy, a number of system atrophy, and clinically undetermined parkinsonism.
Whereas dopamine transporter (DAT) imaging was regularly used to assist in prognosis, the examine discovered that postmortem neuropathological examinations have been solely carried out in 3% of deceased sufferers, with 64% of those confirming the preliminary Parkinson’s illness diagnoses. This decline in postmortem examinations mirrors a worldwide pattern seen in different research.
The examine additionally highlights the issue in differentiating between Parkinson’s illness and dementia with Lewy our bodies, notably in relation to the controversial “one-year rule.”
“This rule, which considers the temporal sequence of motor and cognitive signs, resulted in additional latter instances recognized in comparison with the unique scientific diagnoses. Whereas the one-year rule is utilized in scientific apply, its relevance could also be restricted by the overlap between these issues, with substantial group-level variations however minimal distinctions on the particular person stage,” says Kaasinen.
Pressing want for improved diagnostic processes
“The important thing conclusions of our examine are the pressing want for ongoing refinement of diagnostic processes, enhanced scientific coaching for neurologists, extra frequent use of postmortem diagnostic affirmation, and the event of broadly accessible, cost-effective biomarkers,” Kaasinen summarises.
Growing the speed of autopsies would improve clinicians’ understanding of diagnostic accuracy, notably in instances the place preliminary diagnoses are unclear or revised. The event of cost-effective and accessible biomarkers may enhance diagnostic precision, notably in non-specialised settings, in the end main to higher affected person care.
This retrospective examine was carried out at Turku College Hospital and three regional hospitals in Finland, analysing affected person information from 2006 to 2020. The examine aimed to judge the long-term diagnostic stability of Parkinson’s illness and assess the accuracy of preliminary diagnoses over time in a big cohort of sufferers identified by neurologists, with or with out specialisation in motion issues.
