Pilot study of a three-step diagnostic pathway for young and old patients with Parkinson's disease dementia: screen, test and then diagnose

Objective To pilot a three‐step diagnostic model for young and old patients with Parkinson's disease dementia (PDD). Methods Prospective investigator‐blinded study. We developed a screening questionnaire for patients with Parkinson's disease (PD) and their caregivers. Further, patients were subjected to three screening instruments (Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Addenbrooke's Cognitive Examination‐revised (ACE‐R) and a detailed neuropsychological examination (NPE). Based on the NPE, patients were divided in a PD (without dementia) and a PDD‐group. Results Forty‐one PD patients, aged 37–94 years, participated in this study. Patients were divided in a young group, ≤65 (n = 22) and an old group >65 years (n = 19). In the young group (PDD, n = 5) the patient‐screening questionnaire predicted PDD with a sensitivity/specificity of 100.0%/94.1%; in the old group (PDD, n = 10) the proxy‐screening questionnaire predicted PDD with a sensitivity/specificity of 88.9%/66.7%. In the young group, ACE‐R had the largest Area Under the Curve (AUC) 0.88 (0.70–1.00), in the old group MoCA (AUC 1.00). However, the three instruments did not differ significantly. Conclusions It seems feasible and efficient to use three consecutive diagnostic steps for PDD: (1) a screening questionnaire, (2) if positive: MoCA, FAB or ACE‐R as screening instrument and (3) if positive: a detailed NPE for diagnosing PDD. Copyright © 2009 John Wiley & Sons, Ltd.