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

Chaudhuri, Kallol Ray; Manuel Rojo, Jose; Schapira, Anthony H. V.; Brooks, David J.; Stocchi, Fabrizio; Odin, Per LU ; Antonini, Angelo; Brown, Richard J. and Martinez-Martin, Pablo (2013) In PLoS ONE 8(2).
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... (More)
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%, (kappa(w) = 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. (Less)
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Contribution to journal
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published
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in
PLoS ONE
volume
8
issue
2
publisher
Public Library of Science
external identifiers
  • wos:000315519000079
  • scopus:84874522919
ISSN
1932-6203
DOI
10.1371/journal.pone.0057221
language
English
LU publication?
yes
id
54e04dd7-9c74-452d-be85-f9bb0c45d40d (old id 3657423)
date added to LUP
2013-05-02 09:02:16
date last changed
2019-09-11 02:14:33
@article{54e04dd7-9c74-452d-be85-f9bb0c45d40d,
  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%, (kappa(w) = 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.},
  articleno    = {e57221},
  author       = {Chaudhuri, Kallol Ray and Manuel Rojo, Jose and Schapira, Anthony H. V. and Brooks, David J. and Stocchi, Fabrizio and Odin, Per and Antonini, Angelo and Brown, Richard J. and Martinez-Martin, Pablo},
  issn         = {1932-6203},
  language     = {eng},
  number       = {2},
  publisher    = {Public Library of Science},
  series       = {PLoS ONE},
  title        = {A Proposal for a Comprehensive Grading of Parkinson's Disease Severity Combining Motor and Non-Motor Assessments: Meeting an Unmet Need},
  url          = {http://dx.doi.org/10.1371/journal.pone.0057221},
  volume       = {8},
  year         = {2013},
}