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Identifying parkinsonism in mild cognitive impairment.

Lookup NU author(s): Rishira Fernando, Professor Alan ThomasORCiD, Dr Calum Hamilton, Dr Rory Durcan, Sally Barker, Dr Joanna Ciafone, Nicola Barnett, Kirsty OlsenORCiD, Dr Michael FirbankORCiD, Dr Gemma Roberts, Dr James LloydORCiD, Dr George Petrides, Dr Sean Colloby, Professor Ian McKeith, Professor John O'Brien, Professor John-Paul TaylorORCiD, Dr Paul Donaghy



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Introduction Clinical parkinsonism is a core diagnostic feature for mild cognitive impairment with Lewy bodies (MCI-LB) but can be challenging to identify. A five-item scale derived from the Unified Parkinson’s Disease Rating Scale (UPDRS) has been recommended for the assessment of parkinsonism in dementia. This study aimed to determine whether the five-item scale is effective to identify parkinsonism in MCI. Methods Participants with MCI from two cohorts (n=146) had a physical examination including the UPDRS and [123I]-FP-CIT SPECT striatal dopaminergic imaging. Participants were classified as having clinical parkinsonism (P+) or no parkinsonism (P-), and with abnormal striatal dopaminergic imaging (D+) or normal imaging (D-). The five-item scale was the sum of UPDRS tremor at rest, bradykinesia, action tremor, facial expression, and rigidity scores. The ability of the scale to differentiate P+D+ and P-D- participants was examined. Results The five-item scale had an AUROC of 0.92 in Cohort 1, but the 7/8 cut-off defined for dementia had low sensitivity to identify P+D+ participants (sensitivity 25%, specificity 100%). Optimal sensitivity and specificity was obtained at a 3/4 cut-off (sensitivity 83%, specificity 88%). In Cohort 2, the five-item scale had an AUROC of 0.97, and the 3/4 cut-off derived from Cohort 1 showed sensitivity of 100% and a specificity of 82% to differentiate P+D+ from P-D- participants. The five-item scale was not effective in differentiating D+ from D- participants. Conclusions The five-item scale is effective to identify parkinsonism in MCI, but a lower threshold must be used in MCI compared with dementia.

Publication metadata

Author(s): Fernando R, Thomas A, Hamilton C, Durcan R, Barker S, Ciafone J, Barnett N, Olsen K, Firbank M, Roberts G, Lloyd J, Petrides G, Colloby S, Allan L, McKeith I, O'Brien J, Taylor JP, Donaghy PC

Publication type: Article

Publication status: Published

Journal: Journal of the Neurological Sciences

Year: 2024

Volume: 458

Print publication date: 15/03/2024

Online publication date: 15/02/2024

Acceptance date: 14/02/2024

Date deposited: 08/03/2024

ISSN (print): 0022-510X

ISSN (electronic): 1878-5883

Publisher: Elsevier BV


DOI: 10.1016/j.jns.2024.122941


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Funder referenceFunder name
Alzheimer's Research UK
Cambridge Centre for Parkinson's Plus
GE Healthcare
Medical Research Council
Newcastle University
NIHR Newcastle Biomedical Research Centre
NIHR Cambridge Biomedical Research Centre