Revisiting the 2015 MDS diagnostic criteria for Parkinson disease: insights from autopsy-confirmed cases
The 2015 International Parkinson and Movement Disorder Society (MDS) Diagnostic criteria for Parkinson Disease are based on expert consensus opinion and defines core motor features, 'Absolute Exclusion Criteria' and a balance of 'Supportive Criteria' and 'Red Flags'. To assess validity of each criterion in pathologically-confirmed cases, a scoping literature review between 1988-2024 using search terms for clinicopathological PD and atypical parkinsonian disorders identified 28 articles. Supportive criteria were higher in PD, with excellent levodopa response and rest tremor most useful. Absolute exclusion criteria and red flags were present more often in atypical parkinsonian disorders. However, supranuclear gaze palsy, rapid progression of gait impairment to wheelchair requirement and bilateral symptoms were reported in >5% PD. Data was limited by few appropriate pathological studies with sufficient clinical data; challenges in applying highly-specific definitions to retrospective studies and likely co-pathologies. This review provides empiric data to support some items of the MDS Criteria with future potential refinement.
Authors
- Roongroj Bhidayasiri (ORCID: https://orcid.org/0000-0002-6901-2064)
- Gábor G. Kovács
- Francisco Cardoso (ORCID: https://orcid.org/0000-0003-0808-0116)
- Claudia Trenkwalder (ORCID: https://orcid.org/0000-0001-6407-1199)
- Daniel G. Di Luca (ORCID: https://orcid.org/0000-0002-1356-4919)
- Ronald B. Postuma (ORCID: https://orcid.org/0000-0002-6468-4734)
- Regina Katzenschlager (ORCID: https://orcid.org/0000-0002-2112-9271)
- Susan Helen Fox (ORCID: https://orcid.org/0009-0004-7568-1645)
Institutions
- Universidade Federal de Minas Gerais (BR)
- Montreal Neurological Institute and Hospital (CA)
- Thai Red Cross Society (TH)
- University Health Network (CA)
- Chulalongkorn University (TH)
- University of Toronto (CA)
- Washington University in St. Louis (US)
- Toronto Western Hospital (CA)
- King Chulalongkorn Memorial Hospital (TH)
- Occupational Cancer Research Centre (CA)
- Nephrologisches Zentrum Goettingen (DE)
- Paracelsus Elena Klinik Kassel (DE)
- The Royal College Of Anesthesiologists Of Thailand (TH)
- Hôpital du Sacré-Cœur de Montréal (CA)
- Ontario Brain Institute (CA)
- Karl Landsteiner Society (AT)
- Office of the Royal Society
- McGill University (CA)
Publication Details
- Journal
- npj Parkinson s Disease
- Published
- 2025-12-13
- DOI
- https://doi.org/10.1038/s41531-025-01206-6
- Primary Topic
- Parkinson's Disease Mechanisms and Treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.00