title: Diagnostic accuracy of Parkinson's disease and atypical parkinsonism in nursing homes.
abstract: BACKGROUND
  Management of Parkinson's disease (PD) and atypical parkinsonism in nursing homes depends on a timely and accurate diagnosis. However, little is known about the diagnostic accuracy of these parkinsonian syndromes in nursing homes. We examined this issue in a large group of Dutch nursing home residents.
  
  
  METHODS
  Twelve large nursing home organizations in the Netherlands accounting for 100 nursing homes with a total population of 5480 residents participated. Residents with PD or atypical parkinsonism were identified according to their nursing home medical chart diagnosis. Additionally, local pharmacists provided a list of all residents using antiparkinson medication. We compared the admission diagnosis to a clinical diagnosis made in the study, based upon interview and detailed neurological examination by movement disorders experts. Diagnoses were based on accepted clinical criteria for PD and atypical parkinsonism.
  
  
  RESULTS
  In the total population of 5480 residents, 258 had previously been diagnosed with a form of parkinsonism according to their medical record. In 53 of these residents (20.5%) we changed or rejected the diagnosis. Specifically, we found no parkinsonism in 22 of these 53 residents (8.5% of all patients with suspected parkinsonism). In the remaining 31 residents (12%), we established a new diagnosis within the parkinsonian spectrum.
  
  
  CONCLUSIONS
  In a large population of Dutch nursing home residents, 20% of diagnoses within the parkinsonian spectrum were inaccurate. Almost 9% of residents had inadvertently received a diagnosis of parkinsonism. Better recognition of parkinsonism in nursing homes is important, because of the consequences for management and prognosis.
authors.affiliation: Bronovo Hospital, Department of Neurology, The Hague, The Netherlands; Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands.
authors.forename: N J
authors.initials: NJ
authors.lastname: Weerkamp
authors.affiliation: Bronovo Hospital, Department of Neurology, The Hague, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Tissingh
authors.affiliation: Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands.
authors.forename: P J E
authors.initials: PJ
authors.lastname: Poels
authors.affiliation: Department of General Practice, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: S U
authors.initials: SU
authors.lastname: Zuidema
authors.affiliation: Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Munneke
authors.affiliation: Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Center, The Netherlands.
authors.forename: R T C M
authors.initials: RT
authors.lastname: Koopmans
authors.affiliation: Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, The Netherlands. Electronic address: b.bloem@neuro.umcn.nl.
authors.forename: B R
authors.initials: BR
authors.lastname: Bloem
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D020734:Parkinsonian Disorders / Q000145:classification / Q000175:diagnosis / Q000451:nursing; D012720:Severity of Illness Index
keywords: Atypical parkinsonism; Diagnostic accuracy; Nursing home; Parkinson's disease