title: Enhancing recognition of early Parkinsonism in the community.
abstract: Because Parkinsonism is underdiagnosed in the community, we have validated screening modalities in the field setting and developed a screening procedure to enhance recognition of undiagnosed patients. In a first survey, we identified suspect cases among patients consulting 9 general practitioners (GPs) over a 3-week period using in parallel: (1) a published questionnaire; (2) a standardized examination by the GPs; (3) clinical impression of the GPs; or (4) pre-established diagnoses. Parkinsonism was ascertained by two neurologists with a 1-year follow-up and FP-CIT-SPECT. In total, 1,411 patients consulted the GPs, 1,030 participated in the study, 87 possible cases were identified by at least one of four screening modalities, 12 suffered from Parkinsonism, and 4 of these 12 were de novo cases. Statistical analysis demonstrated that with appropriate evaluation, the questionnaire is highly sensitive and excludes most nonaffected persons, and that the GPs' clinical impression is more specific. We therefore tested in a second survey the efficacy of a serial screening, starting with the questionnaire, followed by a standardized GP evaluation, and then by neurological examination. Of 1,353 participants seen by 9 GPs during a 3-week period, 5 de novo cases were identified. This simple screening protocol significantly enhances recognition of incipient Parkinsonism.
authors.affiliation: Department of Neurology, Philipps-University, Marburg, Germany.
authors.forename: Günter U
authors.initials: GU
authors.lastname: Höglinger
authors.forename: Ida
authors.initials: I
authors.lastname: Rissling
authors.forename: Aline
authors.initials: A
authors.lastname: Metz
authors.forename: Vincent
authors.initials: V
authors.lastname: Ries
authors.forename: Anne
authors.initials: A
authors.lastname: Heinermann
authors.forename: Helge
authors.initials: H
authors.lastname: Prinz
authors.forename: Sybille
authors.initials: S
authors.lastname: Spieker
authors.forename: Günter
authors.initials: G
authors.lastname: Deuschl
authors.forename: Erika
authors.initials: E
authors.lastname: Baum
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Oertel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000378:metabolism; D003153:Community Health Services; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000175:diagnosis*; D011320:Primary Health Care; D021641:Recognition, Psychology; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D015899:Tomography, Emission-Computed, Single-Photon; D014326:Tropanes
chemical_list: D007457:Iodine Radioisotopes; D014326:Tropanes; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane