Parkinson's Disease Screening Initiative: Suggestions for the development of a simple screening tool 公开

De Louis, Fabiola (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/f7623d40s?locale=zh
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Abstract

Background: Parkinson's Disease (PD) is a neurodegenerative disorder that is known to have genetic and environmental components, and the focus of much work in the public health community. With a noted decline of diagnosis in the primary care setting, as well as the vast number of exposures associated with the development of the disease, suggestions for a screening tool were developed in hopes of identifying at risk and marginalized populations that could benefit from services and interventions offered from a specialty provider.

Methods: 14 different questionnaires and 6 different vital signs were evaluated to gauge differences between PD patients and healthy controls, conducted as part of a case-control study. The Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale and clinical variable of orthostatic hypotension were determined to be the best contributors towards the base model for this tool. Questions were dichotomized and selected based off of multiple parameters, including significance, generalizability and potential to be present in PD populations before motor symptoms develop. The final suggested 10 questions were then evaluated utilizing a logistic regression and Receiver Operator Curve analysis.

Results: 9 questions and 1 clinical variable were selected as suggestions for the development of a possible PD screening tool. The suggested tool had an AUC of 0.9298 (95% CI: 0.8749 to 0.9848) with a final sensitivity of 0.93, specificity of 0.82 and a YJ of 0.74 utilizing a set point of 3 or above as a "positive" indication to seek additional follow-up.

Conclusions: This survey should be considered a first step in helping to properly identify symptoms associated in PD in populations without immediate access to a specialist and to prompt them to seek follow-up with a specialty provider for further treatment, diagnosis, and possibly symptomatic management

Table of Contents

1. Introduction

1.2 Literature Review

1.3 Research Objectives

2. Methods

2.1 Study Design

2.2 Data Collection and Analysis

2.3 Study Population

3. Results

3.1. Descriptive Statistics and Clinical Characteristics

3.2. Summary of Question Battery

3.3. UPDRS and MDS-UPDRS

3.4. Orthostatic Hypotension

3.5. Criteria for Screening Use

3.6. Finalization of the Screening Tool

3.7. Association between delay in diagnosis and education level

4. Discussion

5. Limitations

6. Conclusion and Recommendations

References

Appendix I: Tables

Table 1: Characteristics of Entire Cohort

Table 2: Characteristics of Cohort A

Table 3: Characteristics of Cohort B

Table 4: Clinical Characteristics of Cohort A

Table 5: Clinical Characteristics of Cohort B

Table 6: Question Battery Summary

Table 7: Question Battery Summary of Cohort A

Table 8: Question Battery Summary of Cohort B

Table 9: Score breakdown of battery, based on reported cut-offs, Cohort A

Table 10: Score breakdown of battery, based on reported cut-offs, Cohort B

Table 11: Clinical Indicators of Orthostatic Hypotension

Table 12: Odds Ratios of Orthostatic Hypotension

Table 13: Individual Question Assay

Table 14: Questions Selected from the MDS-UPDRS

Table 15: Reported Cut Offs

Table 16: Association Between Education and Time to Diagnosis

Appendix II: Figures

Figure 1: Overview and Rationale Diagram

Figure 2: Study Participants and Cohort Creation

Figure 3: ROC Curve for Suggestive PD Screening Tool

Figure 4: Disease Progression and phases of Parkinson's Disease

Appendix III: Review and Analysis of Additional Questionnaires Utilized in Study Battery

Appendix IV: Suggested Screening Tool

Appendix V: MDS-UPDRS

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