Predicting diagnosis of Parkinson's disease: A risk algorithm based on primary care presentations

Abstract

Background: Diagnosis of Parkinson's disease (PD) is typically preceded by nonspecific presentations in primary care.

Objectives: The objective of this study was to develop and validate a prediction model for diagnosis of PD based on presentations in primary care.

Setting: The settings were general practices providing data for The Health Improvement Network UK primary care database.

Methods: Data from 8,166 patients aged older than age 50 years with incident diagnosis of PD and 46,755 controls were analyzed. Likelihood ratios, sensitivity, specificity, and positive and negative predictive values for individual symptoms and combinations of presentations were calculated. An algorithm for risk of diagnosis of PD within 5 years was calculated using multivariate logistic regression analysis. Split sample analysis was used for model validation with a 70% development sample and a 30% validation sample.

Results: Presentations independently and significantly associated with later diagnosis of PD in multivariate analysis were tremor, constipation, depression or anxiety, fatigue, dizziness, urinary dysfunction, balance problems, memory problems and cognitive decline, hypotension, rigidity, and hypersalivation. The discrimination and calibration of the risk algorithm were good with an area under the curve of 0.80 (95% confidence interval 0.78-0.81). At a threshold of 5%, 37% of those classified as high risk would be diagnosed with PD within 5 years and 99% of those who were not classified as high risk would not be diagnosed with PD.

Conclusion: This risk algorithm applied to routine primary care presentations can identify individuals at increased risk of diagnosis of PD within 5 years to allow for monitoring and earlier diagnosis of PD. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

Keywords: Parkinson's disease; algorithm; diagnosis; prodromal; risk; risk calculator.

Figure 1

Percentage of individual symptom presentations in controls and PD patients. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2

Receiver operating characteristic curves for the prediction of PD for the model with all statistically significant prediagnostic symptom presentations of PD, smoking status, gender, and age group in the development and validation datasets. [Color figure can be viewed at wileyonlinelibrary.com]