الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 118 |  |  |
| | | from | 118 | | |
Abstract
The aim of this study is to detect the time lapse till definite diagnosis of Parkinsonism and possible etiologies and social factors that cause delay of that diagnosis in a population-representative study.
Eighty patients with definite diagnosis of Parkinsonism, as determined by rest tremor, bradykinesia, rigidity, and/or postural instability were included in our study.
We exclude all patients with Tremors rather than Parkinsonian tremors: (Orthostatic tremors, Physiological tremors, senile tremors), severely demented patients, multiple etiologies and those who lack caregiver regarding history.
Duration of this study: between June 2016 and June 2017.
The studied patients were subjected to the following:
A- Systematic history:
1- Type and date of first motor symptom,
2- Date of first physician consultation about symptoms,
3- Diagnosis date,
4- Date of first neurologist visit,
5- Family history of any relative diagnosed with PD.
Dates were recorded to the month.
B- Scales:
1- Unified Parkinson’s Disease Rating Scale (UPDRS)[273].
2- Modified Hoehn and Yahr scores[111].
C- Specific questionare designed to detect the cause of delayed diagnosis applied for two weeks on a sample of patients in our department:
1- Type of first contact (neurologist, other specialty).
2- Type of second contact (neurologist, other specialty).
3- Type of first symptom.
4- First informed diagnosis.
5- Time of final diagnosis.
6- Type of physician that reached the definite diagnosis.
7- Investigations done (cranial,extracranial) .
8- Type of treatment received (specific or not).
9- Compliance on treatment.
10- Patient knowledge about the disease.
We observed that:
• The pathway to the diagnosis of Parkinsonism can be divided into three time intervals: recognition of the symptoms, the decision to seek help and the process of diagnosis.
• Patient knowledge about Parkinsonism plays the most important role. Most patients did not immediately recognize that their symptoms could be part of a disease.
• It was noticed that duration from the first medical contact till definite diagnosis was significantly shorter in those who had neurological consultation as first contact than those who had non neurological consultation.
• Non-specific symptoms of Parkinsonism, slow progression of the disease, symptoms are not acute or life threatening and absence of diagnostic test also attribute to delayed diagnosis of Parkinsonism.
• With regarding gender differences, we observed that it took women longer duration from onset of symptoms to medical consultation compared to men and so, the duration till definite diagnosis with Parkinsonism.
Nevertheless, patients can benefit a lot from an early diagnosis and timely therapeutic intervention, taking into accounts the patient’s personal situation and preferences. Therefore it is important that patients and general practitioners learn to recognize the early symptoms of Parkinsonism and act accordingly.
Recommendations
In order to facilitate an earlier diagnosis of Parkinsonism which enables shared decision making between patients and health care providers, educating general population and even general practioners on possible prodromal symptoms of Parkinsonism should be considered.
The image of Parkinsonism, as it is spread by the media, has to be modified from the classic image of the old man with advanced symptoms to a more complete representation of the disease.
Ideally, we need reliable biomarkers capable of diagnosing PD in the pre-motor phase, but until they exist we will continue to rely on the timely identification of motor symptoms in the community.