Development of a Thai Parkinson's Disease Screening Tool and the Prevalence of Parkinsonism and Parkinson's Disease, Based on a Community Survey in Bangkok

Abstract

Introduction: Few epidemiological data of parkinsonism and Parkinson's disease (PD) exist in Southeast Asia. We aimed to develop and validate a screening tool, and investigate the prevalence of parkinsonism and PD via a community survey. Methods: A PD-screening tool comprising 11 “yes/no” items was developed in a clinical setting and validated in the community. The prevalence of PD and parkinsonism was investigated in a survey that included PD screening tools, face-to-face interviews, and physical examinations. Receiver operating characteristic curves were constructed for a range of cutoff points to explore the screening tool's sensitivity and specificity. Results: Of 1,846 participants surveyed, the mean age was 64.4 ± 8.0 years. The age-standardized prevalence of parkinsonism was 1,954 per 100,000 people, and that of PD was 706. Of 36 parkinsonism cases, 13 were PD, 13 were vascular parkinsonism, 8 were drug-induced parkinsonism, and 2 were head-injury related. Three cases were previously diagnosed with PD. A cutoff score of 5 on the screening tool showed a sensitivity of 98%, a specificity of 94%, and positive and negative likelihood ratios of 16.33 and 0.02, respectively. The area under the curve was 0.985. Conclusions: The prevalence of parkinsonism and PD in Thailand is similar to that in Western countries but slightly higher than that for other Asian countries. Differing methodologies, diagnostic criteria, and case identification strategies may contribute to variations in the reported prevalence of PD. Widespread use of the Thai PD-screening tool should be implemented to facilitate early detection of new cases and, in turn, better healthcare.

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“…Symptoms and signs previously considered in PD and parkinsonism screening questionnaires from previous community and hospital-based PD screening questionnaire development studies were also comprehensively reviewed ( 109–112 ). The Panel then reached a consensus on those items that were likely to indicate the presence of prodromal PD most strongly ( 63 , 64 , 109 , 111 , 113 , 114 ).…”

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“…The prevalence increases to 1.4% in individuals over 60 years of age and rises to 4.33% in those over 85 years of age (Keus et al., 2014). In Thailand, a prevalence of 706 PD patients per 100,000 population has been reported, which is 0.7% below the global average (Muangpaisan et al., 2017). The pathological hallmark of the disease occurs in the substantia nigra region of the brain, particularly in the substantia nigra pars compacta (SNc).…”

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“…The prevalence is approximately 1% in US residents aged 60 years old and is expected to double in the next 10–20 years . A population‐based survey in a Thai community revealed that underdiagnosis of PD was common and that the age‐specific prevalence of PD was 706 per 100 000 population in those over 50 years of age . PD manifests with classic motor symptoms as well as non‐motor symptoms such as cognitive impairment and dementia.…”