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Development and external validation of a prognostic model in newly diagnosed Parkinson disease

Velseboer, Daan C; de Bie, Rob M A; Wieske, Luuk; Evans, Jonathan R; Mason, Sarah L; Foltynie, Thomas; Schmand, Ben; de Haan, Rob J; Post, Bart and Barker, Roger A LU , et al. (2016) In Neurology 86(11). p.93-986
Abstract

OBJECTIVE: To develop a prognostic model to predict disease outcomes in individual patients with Parkinson disease (PD) and perform an external validation study in an independent cohort.

METHODS: Model development was done in the Comorbidity and Aging in Rehabilitation Patients: The Influence on Activities (CARPA) cohort (Netherlands). External validation was performed using the Cambridgeshire Parkinson's Incidence from GP to Neurologist (CamPaIGN) cohort (UK). Both are longitudinal incident cohort studies that prospectively followed up patients with PD from the time of diagnosis. A composite outcome measure was made in which patients were classified as having an unfavorable prognosis when they had postural instability or dementia... (More)

OBJECTIVE: To develop a prognostic model to predict disease outcomes in individual patients with Parkinson disease (PD) and perform an external validation study in an independent cohort.

METHODS: Model development was done in the Comorbidity and Aging in Rehabilitation Patients: The Influence on Activities (CARPA) cohort (Netherlands). External validation was performed using the Cambridgeshire Parkinson's Incidence from GP to Neurologist (CamPaIGN) cohort (UK). Both are longitudinal incident cohort studies that prospectively followed up patients with PD from the time of diagnosis. A composite outcome measure was made in which patients were classified as having an unfavorable prognosis when they had postural instability or dementia at the 5-year assessment (or at the last assessment before loss to follow-up), or had died before this time. The final model was derived with a backward selection strategy from candidate predictor variables that were measured at baseline.

RESULTS: In the resulting model, higher patient age, higher Unified Parkinson's Disease Rating Scale motor examination axial score, and a lower animal fluency score were all associated with a higher probability of an unfavorable outcome. External validation confirmed good discriminative ability between favorable and unfavorable outcomes with an area under the receiver operating characteristic curve of 0.85 (95% confidence interval 0.77-0.93) and a well-calibrated model with a calibration slope of 1.13 and no significant lack of fit (Hosmer-Lemeshow test: p = 0.39).

CONCLUSION: We constructed a model that allows individual patient prognostication at 5 years from diagnosis, using a small set of predictor variables that can easily be obtained by clinicians or research nurses.

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keywords
Aged, Aged, 80 and over, Cohort Studies, Female, Follow-Up Studies, Great Britain, Humans, Longitudinal Studies, Male, Middle Aged, Models, Neurological, Netherlands, Parkinson Disease, Prognosis, Prospective Studies, Journal Article, Research Support, Non-U.S. Gov't, Validation Studies
in
Neurology
volume
86
issue
11
pages
8 pages
publisher
American Academy of Neurology
external identifiers
  • scopus:84961279264
ISSN
1526-632X
DOI
10.1212/WNL.0000000000002437
language
English
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no
id
ca56c00d-a8a7-47c2-946a-a14b5d97fee0
date added to LUP
2016-11-23 13:16:13
date last changed
2017-10-29 04:54:22
@article{ca56c00d-a8a7-47c2-946a-a14b5d97fee0,
  abstract     = {<p>OBJECTIVE: To develop a prognostic model to predict disease outcomes in individual patients with Parkinson disease (PD) and perform an external validation study in an independent cohort.</p><p>METHODS: Model development was done in the Comorbidity and Aging in Rehabilitation Patients: The Influence on Activities (CARPA) cohort (Netherlands). External validation was performed using the Cambridgeshire Parkinson's Incidence from GP to Neurologist (CamPaIGN) cohort (UK). Both are longitudinal incident cohort studies that prospectively followed up patients with PD from the time of diagnosis. A composite outcome measure was made in which patients were classified as having an unfavorable prognosis when they had postural instability or dementia at the 5-year assessment (or at the last assessment before loss to follow-up), or had died before this time. The final model was derived with a backward selection strategy from candidate predictor variables that were measured at baseline.</p><p>RESULTS: In the resulting model, higher patient age, higher Unified Parkinson's Disease Rating Scale motor examination axial score, and a lower animal fluency score were all associated with a higher probability of an unfavorable outcome. External validation confirmed good discriminative ability between favorable and unfavorable outcomes with an area under the receiver operating characteristic curve of 0.85 (95% confidence interval 0.77-0.93) and a well-calibrated model with a calibration slope of 1.13 and no significant lack of fit (Hosmer-Lemeshow test: p = 0.39).</p><p>CONCLUSION: We constructed a model that allows individual patient prognostication at 5 years from diagnosis, using a small set of predictor variables that can easily be obtained by clinicians or research nurses.</p>},
  author       = {Velseboer, Daan C and de Bie, Rob M A and Wieske, Luuk and Evans, Jonathan R and Mason, Sarah L and Foltynie, Thomas and Schmand, Ben and de Haan, Rob J and Post, Bart and Barker, Roger A and Williams-Gray, Caroline H},
  issn         = {1526-632X},
  keyword      = {Aged,Aged, 80 and over,Cohort Studies,Female,Follow-Up Studies,Great Britain,Humans,Longitudinal Studies,Male,Middle Aged,Models, Neurological,Netherlands,Parkinson Disease,Prognosis,Prospective Studies,Journal Article,Research Support, Non-U.S. Gov't,Validation Studies},
  language     = {eng},
  month        = {03},
  number       = {11},
  pages        = {93--986},
  publisher    = {American Academy of Neurology},
  series       = {Neurology},
  title        = {Development and external validation of a prognostic model in newly diagnosed Parkinson disease},
  url          = {http://dx.doi.org/10.1212/WNL.0000000000002437},
  volume       = {86},
  year         = {2016},
}