title: Diagnostic accuracy of parkinsonism syndromes by general neurologists.
abstract: BACKGROUND
  Movement disorder specialists can achieve a high level of accuracy when clinically diagnosing parkinsonism syndromes. However, data about the diagnostic accuracy among general neurologists is limited.
  
  
  OBJECTIVE
  This study investigated the recent diagnostic accuracy of parkinsonism syndromes by general neurologists.
  
  
  METHODS
  A retrospective examination of 1362 post-mortem cases diagnosed in the years 2000-2012 by neuropathologists was performed. Out of these cases, we identified 111 patients who received a clinical parkinsonism diagnosis during life and 122 patients who received a neuropathological diagnosis of a parkinsonism syndrome post-mortem including 11 incidental cases.
  
  
  RESULTS
  Fifty-eight (75.3%) of the 77 patients who had received clinical Parkinson's disease (PD) diagnoses were confirmed after the neuropathological examination. The sensitivity of the clinical diagnosis for idiopathic Parkinson's disease (PD) was 89.2% and the specificity was 57.8%. The corresponding numbers for progressive supranuclear palsy (PSP) were 52.9% and 100%, and for multiple system atrophy (MSA) were 64.3% and 99.0%, respectively.
  
  
  CONCLUSIONS
  Parkinson's disease is heavily overdiagnosed by general neurologists, whereas parkinsonism plus syndromes are underdiagnosed. Despite improvements in the diagnostic methods during recent decades and the development of diagnostic clinical criteria for parkinsonian syndromes, the diagnostic accuracy of Parkinson's disease remains relatively low, and 1/4 of diagnoses are incorrect.
authors.affiliation: Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Department of Neurology, Satakunta Central Hospital, Pori, Finland. Electronic address: jtjout@utu.fi.
authors.forename: Juho
authors.initials: J
authors.lastname: Joutsa
authors.affiliation: Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Maria
authors.initials: M
authors.lastname: Gardberg
authors.affiliation: Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Matias
authors.initials: M
authors.lastname: Röyttä
authors.affiliation: Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Division of Clinical Neurosciences, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Valtteri
authors.initials: V
authors.lastname: Kaasinen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis / Q000453:epidemiology; D009462:Neurology / Q000592:standards; D010300:Parkinson Disease / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013494:Supranuclear Palsy, Progressive / Q000175:diagnosis / Q000453:epidemiology
keywords: Clinicopathological study; Multiple system atrophy; Neuropathology; Parkinson's disease; Progressive supranuclear palsy