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Updated: Jan 8, 2026
Dynamic Digital Biomarkers of Motor and Cognitive Function in Parkinson's Disease
Published on: July 24, 2019
Revisiting the 2015 MDS diagnostic criteria for Parkinson disease: insights from autopsy-confirmed cases
Susan H Fox1, Daniel G Luca2, Ronald B Postuma3,4
1University of Toronto, Movement Disorder Clinic, Edmond J Safra Program in Parkinson Disease, Toronto Western Hospital, Toronto, ON, Canada. Susan.Fox@uhn.ca.
Abstract:
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.
Insights
The 2015 International Parkinson and Movement Disorder Society (MDS) diagnostic criteria for Parkinson disease were reviewed. Supportive criteria like levodopa response and rest tremor are useful, but some red flags appear in Parkinson disease.
Area of Science:
- Neurology
- Movement Disorders
- Pathology
Background:
- The 2015 International Parkinson and Movement Disorder Society (MDS) diagnostic criteria for Parkinson disease (PD) rely on expert consensus.
- These criteria include core motor features, exclusion criteria, supportive criteria, and red flags.
Purpose of the Study:
- To evaluate the validity of the 2015 MDS diagnostic criteria for Parkinson disease.
- To assess the utility of individual criteria in pathologically confirmed cases of Parkinson disease and atypical parkinsonian disorders.
Main Methods:
- A scoping literature review was conducted from 1988 to 2024.
- Search terms included "clinicopathological PD" and "atypical parkinsonian disorders", identifying 28 relevant articles.
Main Results:
- Supportive criteria, particularly excellent levodopa response and rest tremor, were more prevalent in pathologically confirmed Parkinson disease.
- Absolute exclusion criteria and red flags were more common in atypical parkinsonian disorders.
- However, supranuclear gaze palsy, rapid gait impairment, and bilateral symptoms were observed in over 5% of Parkinson disease cases.
Conclusions:
- Empirical data partially supports the 2015 MDS diagnostic criteria for Parkinson disease.
- Refinement of the criteria may be warranted based on findings in pathologically confirmed cases.
- Limitations include the scarcity of suitable clinicopathological studies and challenges in applying criteria retrospectively.
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