Objective: Early diagnosis is important in optimal management of patients with Parkinson’s disease (PD). There are several factors which can contribute to delay in diagnosis, most importantly the motor phenotype. In this study, we wanted to determine the socio-economic causes for delay in diagnosis.  

Background: Early diagnosis is important in optimal management of patients with Parkinson’s disease (PD). There are several factors which can contribute to delay in diagnosis, most importantly the motor phenotype. In this study, we wanted to determine the socio-economic causes for delay in diagnosis.  

Method: We reviewed newly diagnosed PD patients in a movement disorder clinic from 2017-2018. All patients were assessed and diagnosed by a movement disorders specialist. All the newly diagnosed patients with Parkinson’s disease in the past 2 years. We determined the time of onset of symptoms and calculated the latency of diagnosis. We collected the demographic and clinical profile of these patients and analyzed the factors determining delay in diagnosis. Patients were excluded if they could not provide a reliable history of symptom onset or were diagnosed with atypical PD.

Results: We analyzed a total of 76 newly diagnosed Parkinson’s disease patients. The mean latency of diagnosis was 1.8 +/- 1.3 years.  We determined the factors which delayed the diagnosis for more than 1 year in these patients. Absence of insurance (patients on charity care or self-pay) was the single most significant factor for delay in diagnosis (P=0.01).  The mean latency of diagnosis in insured patients was 1.6+/-1.3 years (Medicare- 1.9 +/-1.3, others- 1.4 +/-1.2), compared to 2.5 +/- 0.9 years in uninsured patients. The difference between Medicare and other insured patients was not statistically significant. As the sample size included mostly hispanic patients (60%), it was difficult to determine the differences due to ethnicity in this small sample size. Though non-english speakers had more delay in diagnosis (2.1 +/- 11 Vs 1.7 +/-1/3), this was not statistically significant (0.12). Unlike other similar studies, our data did not show any difference due to gender or type of PD or symptoms at presentation.  

Conclusion: The diagnostic latency may be significant in Parkinson’s disease due to clinical factors such as the motor phenotype. But the demographic and socio-economic factors also play an important role in delay in diagnosis.

References: Breen DP, Evans JR, Farrell K, Brayne C, Barker RA. Determinants of delayed diagnosis in Parkinson’s disease. Journal of neurology. 2013 Aug 1;260(8):1978-81. Wan Y, Zhu Y, Luo Y, Han X, Li Y, Gan J, Wu N, Xie A, Liu Z. Determinants of diagnostic latency in Chinese people with Parkinson’s disease. BMC neurology. 2019 Dec;19(1):120. Lay-Son L, Eloiza C, Trujillo-Godoy O. Delay in the diagnosis of Parkinson’s disease in a Chilean public hospital. Revista medica de Chile. 2015 Jul;143(7):870-3.

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