Parkinson's disease severity levels and MDS-Unified Parkinson's Disease Rating Scale

Martinez‐Martín, Pablo; Rodríguez‐Blázquez, Carmen; Álvarez, Mario; Arakaki, Tomoko; Arillo, V. Campos; Chaná, Pedro; Fernández, William; Garretto, Nélida; Martínez‐Castrillo, Juan Carlos; Rodríguez-Violante, Mayela; Serrano‐Dueñas, Marcos; Ballesteros, Diego; Rojo-Abuín, José Manuel; Chaudhuri, K. Ray; Merello, Marcelo

doi:10.1016/j.parkreldis.2014.10.026

Cited by 249 publications

(179 citation statements)

References 22 publications

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“…Here, cutoffs in each of the four parts of the scale were defined for mild, moderate or severe stages (cutoff points between mild/moderate and moderate/severe levels as follows: Part 1: 10/11 and 21/22; Part 2: 12/13 and 29/30; Part 3: 32/33 and 58/59; and Part 4: 4/5 and 12/13). This can help to better stratify disease severity of PD, identify clinical red flags for advPD and assign treatment strategies with respect to overall disease progression and with a focus on motor symptoms (Martinez-Martin et al 2015). …”

Section: Strategies To Define Diseases Stagesmentioning

confidence: 99%

Classification of advanced stages of Parkinson’s disease: translation into stratified treatments

Krüger

Klucken²,

Weiß

et al. 2017

J Neural Transm

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Advanced stages of Parkinson’s disease (advPD) still impose a challenge in terms of classification and related stage-adapted treatment recommendations. Previous concepts that define advPD by certain milestones of motor disability apparently fall short in addressing the increasingly recognized complexity of motor and non-motor symptoms and do not allow to account for the clinical heterogeneity that require more personalized approaches. Therefore, deep phenotyping approaches are required to characterize the broad-scaled, continuous and multidimensional spectrum of disease-related motor and non-motor symptoms and their progression under real-life conditions. This will also facilitate the reasoning for clinical care and therapeutic decisions, as neurologists currently have to refer to clinical trials that provide guidance on a group level; however, this does not always account for the individual needs of patients. Here, we provide an overview on different classifications for advPD that translate into critical phenotypic patterns requiring the differential therapeutic adjustments. New concepts refer to precision medicine approaches also in PD and first studies on genetic stratification for therapeutic outcomes provide a potential for more objective treatment recommendations. We define novel treatment targets that align with this concept and make use of emerging device-based assessments of real-life information on PD symptoms. As these approaches require empowerment of patients and integration into treatment decisions, we present communication strategies and decision support based on new technologies to adjust treatment of advPD according to patient demands and safety.

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Section: Strategies To Define Diseases Stagesmentioning

confidence: 99%

Classification of advanced stages of Parkinson’s disease: translation into stratified treatments

Krüger

Klucken²,

Weiß

et al. 2017

J Neural Transm

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“…In a previous study, 6 we collected information from four global scales to determine cutoff points for assignment of primary severity levels to the scores of the Movement Disorder Society sponsored version of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). These four scales were the Hoehn and Yahr staging (HY), 7 the Clinical Global Impression-Severity (CGIS), 1 the Patient Global Impression-Severity (PGIS), 2,8 and the Clinical Impression of Severity Index for Parkinson’s disease (CISI-PD).…”

Section: Introductionmentioning

confidence: 99%

Analysis of four scales for global severity evaluation in Parkinson’s disease

Martinez‐Martín

Rojo-Abuín

Rodríguez-Violante

et al. 2016

npj Parkinson's Disease

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Global evaluations of Parkinson’s disease (PD) severity are available, but their concordance and accuracy have not been previously tested. The present international, cross-sectional study was aimed at determining the agreement level among four global scales for PD (Hoehn and Yahr, HY; Clinical Global Impression of Severity, CGIS; Clinical Impression of Severity Index, CISI-PD; and Patient Global Impression of Severity, PGIS) and identifying which of them better correlates with itemized PD assessments. Assessments included additional scales for evaluation of the movement impairment, disability, affective disorders, and quality of life. Spearman correlation coefficients, weighted and generalized kappa, and Kendall’s concordance coefficient were used. Four hundred thirty three PD patients, 66% in HY stages 2 or 3, mean disease duration 8.8 years, were analyzed. Correlation between the global scales ranged from 0.60 (HY with PGIS) to 0.91 (CGIS with CISI-PD). Kendall’s coefficient of concordance resulted 0.76 (P<0.0001). HY and CISI-PD showed the highest association with age, disease duration, and levodopa-equivalent daily dose, and CISI-PD with measures of PD manifestations, disability, and quality of life. PGIS and CISI-PD correlated similarly with anxiety and depression scores. The lowest agreement in classifying patients as mild, moderate, or severe was observed between PGIS and HY or CISI-PD (58%) and the highest between CGIS and CISI-PD (84.3%). The four PD global severity scales agree moderately to strongly among them; clinician-based ratings estimate PD severity, as established by other measures, better than PGIS; and the CISI-PD showed the highest association with measures of impairment, disability, and quality of life.

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“…After excluding patients at Hoehn and Yahr stage 3, we found that the study subjects showed a more pronounced improvement in all scores. The Hoehn and Yahr scale mostly evaluates postural instability and motor impairment, and advanced stages correlate with dopaminergic loss, motor decline, and deterioration of quality of life (15,16). Patients with advanced PD have difficulty learning skills or new tasks (17).…”

Section: Discussionmentioning

confidence: 99%