Singapore general practitioners' awareness of atypical features in early Parkinson's disease

Tan JH
Correspondence: Dr Joo-Hui Tan, june_tan@nuh.com.sg

ABSTRACT
Introduction Parkinson's disease (PD) accounts for 75 percent of cases with parkinsonism. 25 percent of parkinsonian patients have alternative and possibly treatable conditions. Early intervention of these conditions lies in the physician's awareness and recognition of atypical features in patients presenting with parkinsonism. This survey studies Singapore general practitioners' (GPs) ability to identify atypical features and alternative diagnoses in patients suspected of having early PD.
Methods 41 out of 57 GPs attending a local symposium participated in a written questionnaire which had the following outcome measures: the ability to identify neurological features that are atypical in early-stage PD; and the awareness of alternative parkinsonian conditions, other than PD.
Results The mean age of the GPs was 56.0 years (standard deviation [SD] 10.4 years), with 36 males and five females. A mean of 1.6 PD patients were under the care of each GP. Only 33 percent (SD 16 percent) of GPs were aware of atypical features in early PD. If the early atypical feature was one that may occur in late-stage PD, the GPs' awareness was even lower at 19 percent (SD 14 percent). 32 percent of GPs were unable to provide any alternative diagnosis to parkinsonism.
Conclusion This survey suggests a poor level of awareness among Singapore GPs on the identification and presence of alternative parkinsonian conditions. Continuing medical education programmes on PD should emphasise on the diagnostic approach to patients with parkinsonism and the impact of missing the diagnosis of treatable parkinsonian conditions.

Keywords: atypical parkinsonism, continuing medical education, general practitioners, Parkinson’s disease, parkinsonism
Singapore Med J 2007; 48(4): 338–341