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Parkinson’s Disease
Volume 2017, Article ID 4047392, 8 pages
Research Article

Consensus on the Definition of Advanced Parkinson’s Disease: A Neurologists-Based Delphi Study (CEPA Study)

1Department of Neurology, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
2Department of Neurology, Movement Disorders Unit, Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
3Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
4Area of Applied Research, National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain
5Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
6Neurology Service, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain

Correspondence should be addressed to Maria-Rosario Luquin; se.vanu@niuqulr

Received 23 September 2016; Revised 23 December 2016; Accepted 5 January 2017; Published 23 January 2017

Academic Editor: Hélio Teive

Copyright © 2017 Maria-Rosario Luquin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


To date, no consensus exists on the key factors for diagnosing advanced Parkinson disease (APD). To obtain consensus on the definition of APD, we performed a prospective, multicenter, Spanish nationwide, 3-round Delphi study (CEPA study). An ad hoc questionnaire was designed with 33 questions concerning the relevance of several clinical features for APD diagnosis. In the first-round, 240 neurologists of the Spanish Movement Disorders Group participated in the study. The results obtained were incorporated into the questionnaire and both, results and questionnaire, were sent out to and fulfilled by 26 experts in Movement Disorders. Review of results from the second-round led to a classification of symptoms as indicative of “definitive,” “probable,” and “possible” APD. This classification was confirmed by 149 previous participating neurologists in a third-round, where 92% completely or very much agreed with the classification. Definitive symptoms of APD included disability requiring help for the activities of daily living, presence of motor fluctuations with limitations to perform basic activities of daily living without help, severe dysphagia, recurrent falls, and dementia. These results will help neurologists to identify some key factors in APD diagnosis, thus allowing users to categorize the patients for a homogeneous recognition of this condition.