This survey summarized general recognitions and opinions on the diagnosis and treatment of PD since the publication and dissemination of the first edition of Chinese PD diagnosis criteria and treatment guideline in China in 2006. With global populations aging, there are more than two million PD patients in China by rough estimation, accounting for 40% PD patients in the world, which brings heavy economic burden to the communities and families [16
]. Managing the large population of PD patients in clinical practice and getting more and more updated information from the movement disorders specialists in the world, Chinese doctors have significantly improved their ability to make diagnosis and carry out reasonable therapy for PD over the past three decades. However, rare reports focus on medications selection strategy among professional levels of doctors in China [17
As disclosed in this survey, in contrast to the Western Countries, where only the movement disorders specialists have the qualifications to provide consultations to the PD patients referred from other doctors, both general neurologists and physicians are caring for PD patients in China, in addition to movement disorders specialists. In fact, in China neither the numbers of movement disorders clinics nor the movement disorders specialists are sufficient to cope with the increasing PD patients. These differences in our survey among doctors at different levels for PD clinics may reflect at least two aspects: one is a relative shortage of medical professional human resources of movement disorders specialists in China, and the second is that the corresponding subspecialty fellowship training programs are lacking [14
From the perspective of doctors, this survey displays the general features on PD in China: most of the participants have adopted the Chinese PD guideline to instruct the clinical practice of PD; Whereas, CME activity frequency are very low and few of those surveyed have published PD related articles. The phenomenon reflected marked shortcomings of academic summary in routine clinical works among most of the surveyed, especially general neurologists and physicians. These pitfalls partly explained the reasons for shortage of influential multi-center clinical studies and original basic research for PD in China compared to Western countries and Japan.
With respect to diagnostic methods for PD, standard oral levodopa test and conventional MRI were commonly considered for suspected patients in routine practice, whereas SWI, TCS and functional neuroimaging were less referred. In China, relatively expensive functional neuroimaging methods, such as SPECT and PET are not covered by Chinese medical insurances, and few patients would like to choose them. Additionally, for loss of knowledge and shortage of TCS experts in many hospitals, TCS is rarely accepted as a regular method. During the past few years, accumulating cross-sectional and longitudinal studies across the globe indicated that several putative clinical symptoms, including hyposmia [19
], RBD [20
], constipation [21
], depression [22
], might assist the early diagnosis and differential diagnosis for PD. In this survey, nearly 40% of those participants would use aforementioned non-motor symptoms as assistant information in the diagnosis and differential diagnosis for PD in clinical practice. Meanwhile, the difference is significant among different stratified doctors, except anxiety and depression. More studies on pre-motor symptoms are warranted to compare the sensitivity and specificity of each non-motor symptom.
As expected, specialties (physicians, general neurologists and movement disorders specialists, Table ), work places (the hospitals and the located cities, Table ), and the Guideline awareness (Table ) play important roles for reasonable PD medications selection strategy. There was a relatively high level of knowledge on therapeutic strategy under specific circumstance among movement disorders specialists and those from tertiary hospitals. However, the discrepancy between the guideline and clinical practice still exists on management of non-motor symptoms among all of those surveyed: Up to 45.8% of responders selected olanzapine to treat PD patients with psychosis, only 22.9% of those prescribed clozapine. The most often prescribed was donepezil, not rivastigmine, for PD with dementia, etc. Based on those observations, great efforts should be made to take the CME programs for physicians and general neurologists. Popularization activities of PD guideline across the country may be a visible strategy to obtain such purpose. In addition to establishment of clinical fellowship training system, the birth and development of movement disorders clinic team are necessary to standardize the diagnosis and treatment of PD. Interdisciplinary communication and cooperation among physicians, general neurologists and movement disorders specialists are warranted to optimize the management of PD, especially for late stage patients with PD.
However, there are some limitations in this survey. As an on-the-spot investigation, the questionnaire was distributed at various conferences and CME courses. There was a potential selection bias as these meetings attendants were likely more academic active compared to those absentees. Additionally, there are rare studies for cognition and attitude of expertise in the public health populations in China so far. Therefore, a series of investigations focused on the expertise and CME will be promoted on a large scale in the future.