What clinical features are most useful to distinguish definite multiple system atrophy from Parkinson's disease?

Topic: Brain proteins, microglia and lab models

Objectives Few studies have attempted to identify what premortem features best differentiate multiple system atrophy (MSA) from Parkinson's disease (PD). These studies are limited by small sample size, clinical heterogeneity, or lack of postmortem validation. We evaluated the sensitivity and specificity of different clinical features in distinguishing pathologically established MSA from PD. Methods One hundred consecutive cases of pathologically confirmed PD and 38 cases of pathologically confirmed MSA in one Parkinson's disease brain bank were included. All cases had their clinical notes reviewed by one observer (AH). Clinical features were divided into two groups: those occurring up to 5 years after onset of disease and those occurring up to death. Statistical analysis comprised multivariate logistic regression analysis to choose and weight key variables for the optimum predictive model. Results The selected early features and their weightings were: autonomic features (2), poor initial levodopa response (2), early motor fluctuations (2), and initial rigidity (2). A cut off of 4 or more on the ROC curve resulted in a sensitivity of 87.1% and specificity of 70.5%. A better predictive model occurred if the following features up to death were included: poor response to levodopa (2), autonomic features (2), speech or bulbar dysfunction (3), absence of dementia (2), absence of levodopa induced confusion (4), and falls (4). The resulting ROC curve based on individual scores showed a best cut off score of at least 11 of 17 (sensitivity 90.3%, specificity 92.6%). Conclusions Predictive models may help differentiate MSA and PD premortem. Hitherto poorly recognised features, suggestive of MSA, included preserved cognitive function and absence of psychiatric effects from antiparkinsonian medication. Diagnostic accuracy was higher in those models taking into account all clinical features occurring up to death. Further studies need to be based on new incident cohorts of parkinsonian patients with subsequent neuropathological evaluation.

Key findings

• Results The selected early features and their weightings were: autonomic features (2), poor initial levodopa response (2), early motor fluctuations (2), and initial rigidity (2).

Why it matters

This study identified clinical features that best distinguish multiple system atrophy from Parkinson's disease using pathologically confirmed cases. It is about differential diagnosis between these two conditions, not about treating, curing or preventing Alzheimer's disease.

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Study details

• Effect size87.1%; 70.5%; 90.3%
• Evidence strengthLow

Read the original

• DOI: 10.1136/jnnp.68.4.434
• PubMed: 10727478
• Original source →
• Free full text: Journal of Neurology Neurosurgery & Psychiatry →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

@article{wenning2000-10727478,
  author  = {Wenning, G. K. and Ben-Shlomo, Y. and Hughes, A. and Daniel, S. E. and Lees, A. and Quinn, N. P.},
  title   = {{What clinical features are most useful to distinguish definite multiple system atrophy from Parkinson's disease?}},
  journal = {Journal of neurology, neurosurgery, and psychiatry},
  year    = {2000},
  doi     = {10.1136/jnnp.68.4.434},
  pmid    = {10727478},
  url     = {https://doi.org/10.1136/jnnp.68.4.434}
}

Studies this one cites

Referenced by this study and also in the alzhub library, so you can read them here.

• Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop Neurology · 1996-11-01 · usefulness score 55/100 · Getting a diagnosis
• Natural history of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome) and clinical predictors of survival: a clinicopathological study Journal of neurology, neurosurgery, and psychiatry · 1996-06-01 · usefulness score 51/100 · Getting a diagnosis
• A clinicopathologic study of 100 cases of Parkinson's disease Archives of neurology · 1993-02-01 · usefulness score 46/100 · Lewy body dementia

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