A Proposal for a Comprehensive Grading of Parkinson's Disease Severity Combining Motor and Non-Motor Assessments: Meeting an Unmet Need

Kallol Ray Chaudhuri, Jose Manuel Rojo, Anthony H V Schapira, David J. Brooks, Fabrizio Stocchi, Per Odin, Angelo Antonini, Richard J. Brown, Pablo Martinez-Martin

Research output: Contribution to journalArticle

Abstract

Background: Non-motor symptoms are present in Parkinson's disease (PD) and a key determinant of quality of life. The Non-motor Symptoms Scale (NMSS) is a validated scale that allows quantifying frequency and severity (burden) of NMS. We report a proposal for using NMSS scores to determine levels of NMS burden (NMSB) and to complete PD patient classification. Methods: This was an observational, cross-sectional international study of 935 consecutive patients. Using a distribution of NMSS scores by quartiles, a classification based on levels from 0 (no NMSB at all) to 4 (very severe NMSB) was obtained and its relation with Hoehn and Yahr (HY) staging, motor and health-related quality of life scales was analyzed. Concordance between NMSB levels and grouping based on clinician's global impression of severity, using categorical regression, was determined. Disability and HRQoL predictors were identified by multiple regression models. Results: The distribution of motor and QoL scales scores by HY and NMSB levels was significantly discriminative. The difference in the classification of cases for both methods, HY and NMSB, was significant (gamma = 0.45; ASE = 0.032). Concordance between NMSB and global severity-based levels from categorical regression was 91.8%, (kappaw = 0.97). NMS score was predictor of disability and QoL. Conclusions: Current clinical practice does not address a need for inclusion of non-motor scores in routine assessment of PD in spite of the overwhelming influence of NMS on disability and quality of life. Our data overcome the problems of "pure motor assessment" and we propose a combined approach with addition of NMSB levels to standard motor assessments.

Original languageEnglish
Article numbere57221
JournalPLoS One
Volume8
Issue number2
DOIs
Publication statusPublished - Feb 27 2013

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Parkinson disease
disease severity
signs and symptoms (animals and humans)
Parkinson Disease
quality of life
Quality of Life
Cross-Sectional Studies
Health
methodology

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

A Proposal for a Comprehensive Grading of Parkinson's Disease Severity Combining Motor and Non-Motor Assessments : Meeting an Unmet Need. / Ray Chaudhuri, Kallol; Rojo, Jose Manuel; Schapira, Anthony H V; Brooks, David J.; Stocchi, Fabrizio; Odin, Per; Antonini, Angelo; Brown, Richard J.; Martinez-Martin, Pablo.

In: PLoS One, Vol. 8, No. 2, e57221, 27.02.2013.

Research output: Contribution to journalArticle

Ray Chaudhuri, K, Rojo, JM, Schapira, AHV, Brooks, DJ, Stocchi, F, Odin, P, Antonini, A, Brown, RJ & Martinez-Martin, P 2013, 'A Proposal for a Comprehensive Grading of Parkinson's Disease Severity Combining Motor and Non-Motor Assessments: Meeting an Unmet Need', PLoS One, vol. 8, no. 2, e57221. https://doi.org/10.1371/journal.pone.0057221
Ray Chaudhuri, Kallol ; Rojo, Jose Manuel ; Schapira, Anthony H V ; Brooks, David J. ; Stocchi, Fabrizio ; Odin, Per ; Antonini, Angelo ; Brown, Richard J. ; Martinez-Martin, Pablo. / A Proposal for a Comprehensive Grading of Parkinson's Disease Severity Combining Motor and Non-Motor Assessments : Meeting an Unmet Need. In: PLoS One. 2013 ; Vol. 8, No. 2.
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abstract = "Background: Non-motor symptoms are present in Parkinson's disease (PD) and a key determinant of quality of life. The Non-motor Symptoms Scale (NMSS) is a validated scale that allows quantifying frequency and severity (burden) of NMS. We report a proposal for using NMSS scores to determine levels of NMS burden (NMSB) and to complete PD patient classification. Methods: This was an observational, cross-sectional international study of 935 consecutive patients. Using a distribution of NMSS scores by quartiles, a classification based on levels from 0 (no NMSB at all) to 4 (very severe NMSB) was obtained and its relation with Hoehn and Yahr (HY) staging, motor and health-related quality of life scales was analyzed. Concordance between NMSB levels and grouping based on clinician's global impression of severity, using categorical regression, was determined. Disability and HRQoL predictors were identified by multiple regression models. Results: The distribution of motor and QoL scales scores by HY and NMSB levels was significantly discriminative. The difference in the classification of cases for both methods, HY and NMSB, was significant (gamma = 0.45; ASE = 0.032). Concordance between NMSB and global severity-based levels from categorical regression was 91.8{\%}, (kappaw = 0.97). NMS score was predictor of disability and QoL. Conclusions: Current clinical practice does not address a need for inclusion of non-motor scores in routine assessment of PD in spite of the overwhelming influence of NMS on disability and quality of life. Our data overcome the problems of {"}pure motor assessment{"} and we propose a combined approach with addition of NMSB levels to standard motor assessments.",
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