Pitfalls and caveats in the diagnostic pathway of people with Parkinson’s disease

Abstract

Objective: We carried out a cross-sectional study to identify the factors involved in each stage of the diagnosis pathway that may lead to a diagnostic delay in persons with Parkinson’s disease (PD). Materials and Methods: Consecutive patients with PD were included. A questionnaire assessing the recognition of the initial symptoms, pathway to seek attention diagnosis and perception on the diagnostic time and identified barriers was applied. Diagnosis delay was defined as ≥ 12 months between initial recognition of the symptom and the definitive diagnosis of PD. Results: A total of 114 patients (57.9% male) with PD were included in the study. The overall median time of the diagnosis pathway was 14.5 (interquartile range [IQR] 31) months and the longest time in this pathway was between the first medical consultation and the definitive diagnosis of PD, a median of 9 (IQR 14) months. The main appraisal of the first symptom was being “not worried” (48.2%). The mains reasons for seeking medical attention were symptom worsening (42.1%). Patient’s perception on the diagnostic time was reported as very adequate/adequate in 52.7%. Barriers delaying the diagnosis identified included the belief of spontaneous symptoms relief and lack of trust in their doctor. Conclusion: Both the person with PD and the physician play a shared role in the diagnosis of PD. Improving the awareness of the disease, as well as improving medical education on PD, could result in a timely diagnosis.

Keywords

• Parkinson’s disease. Delayed diagnosis. Diagnosis pathway. Primary health care. Diagnosis.