Prevalence of Thai patients with advanced Parkinson's disease and external validation of the 5–2-1 Criteria and the CDEPA Questionnaire: A single-centered, cross-sectional study

Abstract

Background: Advanced stage of Parkinson's disease (APD) diagnosis is challenging for general neurologists. The 5–2–1 Criteria and the Cuestionario De Enfermedad de Parkinson Avanzada (CDEPA) have been validated for screening for APD. Objective: This article reports the period-prevalence of APD defined by a movement disorder expert, the 5–2–1 Criteria, and CDEPA and to improve the screening performance of the 5–2–1 Criteria Methods: A cross-sectional retrospective study at the Parkinson's disease (PD) clinic of a tertiary hospital in Bangkok, Thailand amongst all PD patients aged ≥ 18 years was performed from January 2016 to January 2020. We compared the characteristics of APD and non-APD patients. We externally validated the 5–2–1 Criteria and CDEPA. We explored improving the 5–2–1 Criteria. Results: Of 480 PD patients with complete data, the period-prevalence of APD by the movement disorder expert, the 5–2–1 Criteria and CDEPA were 37.1 %, 48.5 %, and 27.5 %, respectively. Adding requiring help with an activity of daily living and freezing of gait to the original 5–2–1 Criteria enhanced the sensitivity from 86.5 % (95 %CI 80.6, 91.2) to 94.9 % (95 %CI 90.6, 97.7) and negative predictive value (NPV) from 90.3 % (95 %CI 85.9, 93.7) to 96 % (95 %CI 92.6, 98.2). However, the CDEPA had a sensitivity of 62.9 % (95 %CI 55.4, 70) and NPV of 81.0 (95 %CI 76.5, 85). Conclusion: The 5–2–1 Criteria had a good screening tool performance for general neurologists to refer APD patients for optimal treatments. The modified 5–2–1 Criteria had better performance than the original one. External validation is needed.