Distinct Clinical Implications of Patient‐ Versus Clinician‐Rated Motor Symptoms in Parkinson's Disease

Abstract

BackgroundPatient‐rated motor symptoms (PRMS) and clinician‐rated motor symptoms (CRMS) often differ in Parkinson's disease (PD).ObjectiveOur goal was to investigate the determinants and clinical implications of PRMS compared with CRMS in PD.MethodsThis retrospective, observational cohort study analyzed the cross‐sectional associations and longitudinal impacts of PRMS as assessed by the Movement Disorders Society‐sponsored Unified PD Rating Scale (MDS‐UPDRS) part 2, while controlling for CRMS measured by MDS‐UPDRS part 3. Longitudinal analyses used Cox proportional hazards models and multiple linear mixed‐effects random intercepts/slope models, adjusting for many clinical predictors. We conducted propensity score matching (PSM) to reinforce our analyses' robustness and surface‐based morphometry to investigate neural correlates.ResultsWe enrolled 442 patients with early‐stage PD. At baseline, regardless of CRMS, PRMS were associated with the severity of postural instability and gait disturbance (PIGD). Notably, PRMS independently and more accurately predicted faster long‐term deterioration in motor function than CRMS (Hoehn and Yahr 4, adjusted hazard ratio per +1 point = 1.19 [95% confidence intervals, 1.08–1.32]), particularly in PIGD (PIGD subscore, β‐interaction = 0.052 [95% confidence intervals, 0.018–0.086]). PSM confirmed these findings' robustness. Surface‐based morphometry suggested that enhanced sensory processing was distinctively associated with PRMS.ConclusionsIn early‐stage PD, PRMS weighed different aspects of symptoms and more effectively predicted motor deterioration compared to CRMS, with distinctive brain structural characteristics. The superior sensitivity of PRMS to subtle declines in drug‐refractory symptoms like PIGD likely underlie our results, highlighting the importance of understanding the differential clinical implications of PRMS to prevent long‐term motor deterioration. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.