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A recent consensus statement published in Neurology Clinical Practice provides a differential diagnosis algorithm that may be helpful for use by general neurologists who are seeing patients with a potential atypical parkinsonian disorder (APD). The statement includes an overarching flow diagram outlining the sequence of diagnosis, with accompanying tables detailing the symptoms, imaging features, biomarker results, and other clinical features. Authors of the statement included members of the Diagnosis and Treatment Working Group of the CurePSP Center of Care Network.
APDs include conditions such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal syndrome (CBS), and dementia with Lewy bodies (DLB), which each have formal diagnostic criteria requiring subspecialty experience and the exclusion of competing diagnoses. As such, in the context of a general neurology clinic, diagnosis of APDs may be challenging early in the disease course when symptoms may be ambiguous and competing diagnoses may be difficult to rule out. The authors of the consensus statement explain that their differential diagnosis algorithm is intended to equip general neurologists or subspecialists who are not in the fields of movement disorders or behavioral neurology with the ability to make at least a provisional diagnosis of APD, potentially allowing for earlier diagnosis, enabling more prompt management of symptoms, resource provision, communication of disease-specific information, and the possibility of clinical trial participation.
The authors emphasize that the diagnosis of APDs is an iterative process, underscore that diagnostic testing techniques are evolving, and reinforce the critical role of obtaining a detailed patient history and conducting a thorough neurologic examination. The authors recommend that neurologists communicate with patients to explain the need for all diagnostic tests and repeat visits.
The consensus statement is available on the Neurology website as an open access article: https://www.neurology.org/doi/10.1212/CPJ.0000000000200345