Clinical Presentation of Parkinson’s Disease: Experience of using Movement Disorder Society Clinical Diagnostic Criteria for Parkinson’s Disease

Abstract

Aims: Parkinson’s disease (PD) is a common neurodegenerative disorder. As no definite diagnostic tests are available, diagnosis is done mostly clinically. UK Brain Bank criteria is commonly used globally for that purpose. In this study we used Movement Disorder Society (MDS) Clinical Diagnostic Criteria to diagnose PD and document the clinical presentations. Study design: Descriptive cross-sectional study. Methodology: This study was carried out in the department of neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from May 2018 to April 2019. Total 42 patients (4 clinically established and 38 clinically probable PD) were enrolled as study population according to Movement Disorder Society (MDS) Clinical Diagnostic Criteria - 2015 for PD. Their patterns of clinical presentation were recorded. Results: Among the PD patients, 31 were male and 11 were female. Mean age of all patients was 59.43 ± 11.34 years. The most common presenting feature was tremulous movement (90.5%) followed by slowness of movement (40.5%). Only 9% patients had early onset PD. All patients had history of positive response to dopaminergic therapy with documented resting tremor in 95.2%, and end-of-dose wearing off in 75.6%. Constipation was the commonest (69%) non motor symptom followed by sleep dysfunction (64.3%) & depression (50%). On examination- 100% patients had bradykinesia, 97.6% rest tremor, 95.2% rigidity, 21.4% mild dementia and 4.8% moderate dementia. Also 26.2% patients were found to have postural hypotension. 4 patients had red flag features- urinary retention was found in three patients and one patient suffered from recurrent early fall. Conclusion: MDS Clinical Diagnostic Criteria   help in accurate diagnosis of PD and include more clinical features which will help in formulating management plan.