Clinical classification systems and long-term outcome in mid- and late-stage Parkinson’s disease
Ygland Rödström, Emil LU and Puschmann, Andreas LU
(2021)
In npj Parkinson's Disease
7(1).
- Abstract
Parkinson’s disease shows a heterogeneous course and different clinical subtyping systems have been described. To compare the capabilities of two clinical classification systems, motor-phenotypes, and a simplified clinical motor-nonmotor subtyping system, a cohort was included at mean 7.9 ± 5.3 years of disease duration, classified using both clinical systems, and reexamined and reclassified at the end of an observation period. Time-points were retrospectively extracted for five major disease milestones: death, dementia, Hoehn and Yahr stage 5, nursing home living, and walking aid use. Eighty-nine patients were observed for 8.1 ± 2.7 years after inclusion. Dementia developed in 32.9% of the patients and 36.0–67.4% reached the other... (More)
Parkinson’s disease shows a heterogeneous course and different clinical subtyping systems have been described. To compare the capabilities of two clinical classification systems, motor-phenotypes, and a simplified clinical motor-nonmotor subtyping system, a cohort was included at mean 7.9 ± 5.3 years of disease duration, classified using both clinical systems, and reexamined and reclassified at the end of an observation period. Time-points were retrospectively extracted for five major disease milestones: death, dementia, Hoehn and Yahr stage 5, nursing home living, and walking aid use. Eighty-nine patients were observed for 8.1 ± 2.7 years after inclusion. Dementia developed in 32.9% of the patients and 36.0–67.4% reached the other milestones. Motor-phenotypes were unable to stratify risks during this period, but the worst compared with the more favorable groups in the motor-nonmotor system conveyed hazard ratios between 2.6 and 63.6 for all milestones. A clear separation of risks for dying, living at the nursing home, and reaching motor end-stage was also shown when using only postural instability and gait disorder symptoms, without weighing them against the severity of the tremor. At reexamination, 29.4% and 64.7% of patients had changed classification groups in the motor-phenotype and motor-nonmotor systems, respectively. The motor-nonmotor system thus stratified risks of reaching crucial outcomes in mid–late Parkinson’s disease far better than the well-studied motor-phenotypes. Removing the tremor aspect of motor-phenotypes clearly improved this system, however. Classifications in both systems became unstable over time. The simplification of the motor-nonmotor system was easily applicable and showed potential as a prognostic marker during a large part of Parkinson’s disease.
(Less)
- author
- Ygland Rödström, Emil
LU
and Puschmann, Andreas
LU
- organization
- publishing date
- 2021-12
- type
- Contribution to journal
- publication status
- published
- subject
- in
- npj Parkinson's Disease
- volume
- 7
- issue
- 1
- article number
- 66
- publisher
- Springer Nature
- external identifiers
-
- scopus:85112107291
- pmid:34341343
- ISSN
- 2373-8057
- DOI
- 10.1038/s41531-021-00208-4
- language
- English
- LU publication?
- yes
- additional info
- Funding Information: This study was partially supported by Governmental funding for clinical research within the Swedish National Health Services (ALF), MultiPark–a strategic research environment at Lund University, Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research, the Swedish Parkinson Foundation (Parkinsonfon-den), the Swedish Parkinson Academy and Bundy Academy, all in Sweden. Open access funding provided by Lund University. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
- id
- 041c5833-0165-4b58-849f-dad279fe78d9
- date added to LUP
- 2021-08-16 09:55:47
- date last changed
- 2024-06-15 14:22:41
@article{041c5833-0165-4b58-849f-dad279fe78d9,
abstract = {{<p>Parkinson’s disease shows a heterogeneous course and different clinical subtyping systems have been described. To compare the capabilities of two clinical classification systems, motor-phenotypes, and a simplified clinical motor-nonmotor subtyping system, a cohort was included at mean 7.9 ± 5.3 years of disease duration, classified using both clinical systems, and reexamined and reclassified at the end of an observation period. Time-points were retrospectively extracted for five major disease milestones: death, dementia, Hoehn and Yahr stage 5, nursing home living, and walking aid use. Eighty-nine patients were observed for 8.1 ± 2.7 years after inclusion. Dementia developed in 32.9% of the patients and 36.0–67.4% reached the other milestones. Motor-phenotypes were unable to stratify risks during this period, but the worst compared with the more favorable groups in the motor-nonmotor system conveyed hazard ratios between 2.6 and 63.6 for all milestones. A clear separation of risks for dying, living at the nursing home, and reaching motor end-stage was also shown when using only postural instability and gait disorder symptoms, without weighing them against the severity of the tremor. At reexamination, 29.4% and 64.7% of patients had changed classification groups in the motor-phenotype and motor-nonmotor systems, respectively. The motor-nonmotor system thus stratified risks of reaching crucial outcomes in mid–late Parkinson’s disease far better than the well-studied motor-phenotypes. Removing the tremor aspect of motor-phenotypes clearly improved this system, however. Classifications in both systems became unstable over time. The simplification of the motor-nonmotor system was easily applicable and showed potential as a prognostic marker during a large part of Parkinson’s disease.</p>}},
author = {{Ygland Rödström, Emil and Puschmann, Andreas}},
issn = {{2373-8057}},
language = {{eng}},
number = {{1}},
publisher = {{Springer Nature}},
series = {{npj Parkinson's Disease}},
title = {{Clinical classification systems and long-term outcome in mid- and late-stage Parkinson’s disease}},
url = {{http://dx.doi.org/10.1038/s41531-021-00208-4}},
doi = {{10.1038/s41531-021-00208-4}},
volume = {{7}},
year = {{2021}},
}