Movement Disorder Society‐sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS‐UPDRS): Process, format, and clinimetric testing plan

Goetz, Christopher G.; Fahn, Stanley; Martinez‐Martín, Pablo; Poewe, Werner; Sampaio, Cristina; Stebbins, Glenn T.; Stern, Matthew B.; Tilley, Barbara C.; Dodel, Richard; Dubois, Bruno; Holloway, Robert G.; Jankovic, Joseph; Kulisevsky, Jaime; Lang, Anthony E.; Lees, Andrew J.; Leurgans, Sue E.; LeWitt, Peter A.; Nyenhuis, David L.; Olanow, C. Warren; Rascol, Olivier; Schrag, Anette; Teresi, Jeanne A.; Hilten, Jacobus J. van; LaPelle, Nancy R.

doi:10.1002/mds.21198

Cited by 1,179 publications

(898 citation statements)

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“…Most enrolled participants were unaware of their genetic status. While measures varied slightly between sites, all participants completed a study visit that included historical information on clinical features and treatment, neurological examination including quantitative motor measures utilizing the Unified Parkinson Disease Rating Scale (UPDRS,10) and MDS‐UPDRS11 Hoehn and Yahr rating scale,12 and disability from the Schwab‐England rating scale. Information on nonmotor PD features included measures of cognition (Montreal Cognitive Assessment, MoCA,13), mood (Geriatric Depression scale, abbreviated version GDS15,14 Beck Depression Inventory, BDI15), dysautonomia (SCOPA‐AUT,16), olfaction (UPSIT17), and sleep (Epworth Sleepiness Scale, ESS18 and REM sleep behavior disorder questionnaire, RBDSQ19).…”

Section: Subjects/materials and Methodsmentioning

confidence: 99%

Sex differences in LRRK2 G2019S and idiopathic Parkinson's Disease

Luciano

Wang

Ortega

et al. 2017

Ann Clin Transl Neurol

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ObjectiveTo evaluate sex differences and the relative effect of G2019S LRRK2 mutations in Parkinson's disease (PD).Methods530 LRRK2 PD carriers and 759 noncarrier PD (idiopathic, IPD) evaluated as part of the Fox Foundation (MJFF) Consortium were included. All participants completed a study visit including information on clinical features, treatment, examination, and motor and nonmotor questionnaires. Clinical features were compared between men and women separately for IPD and LRRK2 PD; and features were compared between IPD and LRRK2 PD separately for men and women.Results Among IPD: men had higher levodopa equivalency dose (LED), worse activities of daily living and motoric severity but lower complications of therapy (UPDRS‐IV). IPD women had higher olfaction and thermoregulatory scores and were more likely to report family history of PD. Among LRRK2 PD: Male predominance was not observed among G2019S LRRK2 cases. Women had worse UPDRS‐IV but better olfaction. Among same sex:LRRK2 men and women had better olfaction than IPD counterparts. LRRK2 men demonstrated lower motor and higher cognitive, RBD and thermoregulation scores than IPD men and LRRK2 women had greater UDPRS‐IV and rates of dyskinesia.InterpretationThere were clinical differences between sexes with a more severe phenotype in IPD men and more complications of therapy in women. The more severe male phenotype was moderated by LRRK2, with LRRK2 men and women showing less diversity of phenotype. Our study supports that both genetics and sex drive phenotype, and thus trials in LRRK2 and IPD should consider gender stratification in design or analysis.

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Section: Subjects/materials and Methodsmentioning

confidence: 99%

Sex differences in LRRK2 G2019S and idiopathic Parkinson's Disease

Luciano

Wang

Ortega

et al. 2017

Ann Clin Transl Neurol

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“…The Movement Disorder Society-revised Unified Parkinson's Disease Rating Scale (UPDRS) was performed in the practically defined 'off' state (Goetz et al, 2007). A history of falls was also documented.…”

Section: Subjects and Clinical Test Batterymentioning

confidence: 99%

Heterogeneity of Cholinergic Denervation in Parkinson's Disease without Dementia

Bohnen

Müller

Kotagal

et al. 2012

J Cereb Blood Flow Metab

167

173

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Parkinson's disease (PD) is a multisystem neurodegenerative disorder. Heterogeneous clinical features may reflect heterogeneous changes in different brain regions. In contrast to the pronounced nigrostriatal denervation characteristic of PD, cholinergic changes are less marked. We investigated cholinergic innervation activity in PD subjects relative to normal subjects. Nondemented PD subjects (n = 101, age 65.3±7.2 years) and normal subjects (n = 29, age 66.8 ± 10.9 years) underwent clinical assessment and [ 11 C]methyl-4-piperidinyl propionate acetylcholinesterase and [ 11 C]dihydrotetrabenazine monoaminergic positron emission tomography (PET) imaging. Cholinergic projection changes were heterogeneous for 65 out of 101 PD subjects who had neocortical and thalamic acetylcholinesterase activity within the normal range. The remainder had combined neocortical and thalamic (13/101), isolated neocortical (18/101), or isolated thalamic (5/101) acetylcholinesterase activity below the normal range. The low neocortical acetylcholinesterase activity subgroup had significantly lower global cognitive performance compared with the normal range subgroup (F = 7.64, P = 0.0069) with an independent effect for nigrostriatal denervation (F = 7.60, P = 0.0074). The low thalamic acetylcholinesterase activity subgroup did not differ from the normal thalamic acetylcholinesterase activity subgroup in cognitive performance or motor impairments except for a history of falls (P = 0.0023). Cholinergic denervation is heterogeneous with reduced neocortical and/or thalamic acetylcholinesterase activity in 36% of nondemented PD subjects with corresponding clinical phenotypic variation. Results also show independent cognitive effects for both cholinergic and dopaminergic system changes in nondemented PD subjects.

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“…The diagnoses of PD were based on disease history, clinical examinations, scale evaluations, response to dopaminergic medications, and exclusion of other neurologic and psychiatric diseases, according to the UK Parkinson's Disease Society Brain Bank criteria. While off medication, all patients were given a battery of clinical tests, including the UPDRS (Goetz et al., 2007), the Hoehn and Yahr scale (Hoehn & Yahr, 1967), the Mini‐Mental State Examination (MMSE) (Folstein, Folstein, & McHugh, 1975), and the Hamilton Depression Rating Scale (HDRS) (Hamilton, 1960). Twenty‐three patients were taking stable dopaminergic medications, and 18 patients had received no treatment prior to the date that the scans were performed.…”

Section: Methodsmentioning

confidence: 99%

Increased thalamic centrality and putamen–thalamic connectivity in patients with parkinsonian resting tremor

Cao

Xuan

et al. 2016

Brain and Behavior

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IntroductionEvidence has indicated a strong association between hyperactivity in the cerebello‐thalamo‐motor cortical loop and resting tremor in Parkinson's disease (PD). Within this loop, the thalamus serves as a central hub based on its structural centrality in the generation of resting tremor. To study whether this thalamic abnormality leads to an alteration at the whole‐brain level, our study investigated the role of the thalamus in patients with parkinsonian resting tremor in a large‐scale brain network context.MethodsForty‐one patients with PD (22 with resting tremor, TP and 19 without resting tremor, NTP) and 45 healthy controls (HC) were included in this resting‐state functional MRI study. Graph theory‐based network analysis was performed to examine the centrality measures of bilateral thalami across the three groups. To further provide evidence to the central role of the thalamus in parkinsonian resting tremor, the seed‐based functional connectivity analysis was then used to quantify the functional interactions between the basal ganglia and the thalamus.ResultsCompared with the HC group, patients with the TP group exhibited increased degree centrality (p < .04), betweenness centrality (p < .01), and participation coefficient (p < .01) in the bilateral thalami. Two of these alterations (degree centrality and participation coefficient) were significantly correlated with tremor severity, especially in the left hemisphere (p < .02). The modular analysis showed that the TP group had more intermodular connections between the thalamus and the regions within the cerebello‐thalamo‐motor cortical loop. Furthermore, the data revealed significantly enhanced functional connectivity between the putamen and the thalamus in the TP group (p = .027 corrected for family‐wise error).ConclusionsThese findings suggest increased thalamic centrality as a potential tremor‐specific imaging measure for PD, and provide evidence for the altered putamen–thalamic interaction in patients with resting tremor.

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Movement Disorder Society‐sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS‐UPDRS): Process, format, and clinimetric testing plan

Abstract: This article presents the revision process, major innovations, and clinimetric testing program for the Movement

Cited by 1,179 publications

References 5 publications

Sex differences in LRRK2 G2019S and idiopathic Parkinson's Disease

Sex differences in LRRK2 G2019S and idiopathic Parkinson's Disease

Heterogeneity of Cholinergic Denervation in Parkinson's Disease without Dementia

Increased thalamic centrality and putamen–thalamic connectivity in patients with parkinsonian resting tremor

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