| Abstract |
Introduction: Parkinson Disease (PD) constitutes the second most common neurodegenerative disorder in the general population with a frequency that increases with age, causing significant disability to patients and their families. Given the excellent response of PD symptoms to levodopa treatment during the first years, an early diagnosis is deemed necessary. However, according to literature, diagnosis presents various delays. Approximately 1,200 PD patients are thought to live in the island of Crete, where an extended network of Primary Health Care facilities can be found. Introducing such a screening tool in these sites and encouraging its use by general practitioners and nurses would, thus, facilitate neurologists in the timely diagnosis of PD.
Aim: The aim of our study was to create an original screening tool in order to detect Parkinson’s Disease (PD) in the community.
Methods: Firstly, we performed a systematic literature review considering published screening tools aiming to detect PD patients in the community. Based on the identified screening tools we designed our preliminary questionnaire. Four movement disorders experts and general neurologists were asked to evaluate the questionnaire which was further optimized based on their suggestions. Finally, we applied the screening tool in a small sample of PD patients and healthy individuals. Their comments were used to further improve our screening tool and finalize it.
Results: We found 10 studies, wherein investigators used questionnaires, either self-administered or not, which examined the existence of motor and/ or non-motor symptoms, while a clinical examination was also included in some of them. In the majority of these studies, positive results of the screening tool were confirmed by a neurologist’s examination. However, in many cases the same principle did not apply for negative results due to cost – effect reasons, leading to bias.
Using the conclusions and suggestions of those past attempts, we designed our own original screening tool. We decided to form a questionnaire, excluding clinical examination, to allow a wider variety of healthcare professionals to use the tool in their clinical practice without any preceding special training in movement disorders. We also chose to check for both motor and non-motor symptoms via simple questions. Finally, we wanted our screening tool to be administered by healthcare professionals, since this approach was associated with higher sensitivity and specificity.
Our questionnaire was initially reviewed by four neurologists who commented on whether they thought it was useful, understandable, and accurate enough in detecting PD in the community. They were also asked to make suggestions in order to improve its application based on their experience. Our questionnaire was then updated accordingly, and a pilot study took place (sample of seven PD patients and five healthy controls) to assess: 1) its accuracy in detecting PD symptoms, 2) whether the questions were comprehensible enough for subjects of different ages and educational backgrounds, and 3) whether any more adjustments could be made to meet the patients’ and their caregivers’ perspective on PD. Using their feedback, we decided to add some extra questions about motor symptoms (freezing, rigidity camptocormia, reduced arm swinging). We also weighed each question with a different coefficient, highlighting questions about motor symptoms over non-motor symptoms and family history.
Conclusion: We created a screening tool to detect PD and prodromal PD in the community based on previous knowledge arising from selective literature review, and based on the experience of a group of neurologists, and the application of our tool in a small sample of patients and controls (pilot study).
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Δημιουργία και στάθμιση ενός εργαλείου διαλογής για τη νόσο του Πάρκινσον
