Prognostic factors of motor impairment, disability, and quality of life in newly diagnosed PD

Velseboer, Daan C.; Broeders, Mark; Post, Bart; Geloven, Nan van; Speelman, Johannes D.; Schmand, Ben; Haan, Rob J. de; Bie, Rob M.A. de

doi:10.1212/wnl.0b013e318281cc99

Cited by 73 publications

(73 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the selected predictor variables are largely in line with those found in our earlier reports. 2,[4][5][6] Future validation in a third independent cohort might still increase the robustness of the present study. Since the present model is only validated for newly diagnosed patients with PD, additional independent validation in a cohort with prevalent patients with PD is also needed to investigate whether predictions also hold Abbreviation: UPDRS-ME 5 Unified Parkinson's Disease Rating Scale motor examination.…”

mentioning

confidence: 78%

“…3 Through longitudinal follow-up of our incident PD cohorts in the Netherlands and the United Kingdom, we have previously identified a number of baseline clinical characteristics associated with poor outcomes, including older age, non-levodopa-responsive motor symptoms, and deficits on semantic fluency and pentagon copying tests. 2,[4][5][6] However, these previous analyses have mainly been explorative in nature and while they may allow subgroups of patients at higher or lower risk of a poor outcome to be defined, they do not allow prognostication on an individual basis. The latter would be of considerable use in selecting patients for clinical trials.…”

mentioning

confidence: 99%

“…Model development was performed using data from the Comorbidity and Aging in Rehabilitation Patients: The Influence on Activities (CARPA) study. [6][7][8] The CARPA study is a clinic-based longitudinal prospective cohort study of newly diagnosed patients with PD from outpatient clinics in 6 general hospitals in the Netherlands, recruited between July 2002 and April 2005. Clinical diagnoses of PD were based on the criteria from Gelb et al, 9 and were reevaluated at the 5-year assessment by a movement disorder specialist.…”

mentioning

confidence: 99%

“…We specifically chose a composite outcome including the presence of postural instability or dementia because these are important determinants of disability in PD that are both non-levodopa-responsive. 5,6 In future clinical trials investigating disease-modifying effects of dopaminergic cell-based therapies, patients with PD who are likely to develop one of these nonlevodopa-responsive symptoms within 5 years can be selectively excluded. Conversely, this high-risk group can be positively selected for trials of other types of disease-modifying therapies, to enable changes in outcome to be assessed within a shorter time period.…”

mentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2016

View full text Add to dashboard Cite

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 5 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. Neurology ® 2016;86:986-993

show abstract

mentioning

confidence: 78%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Five studies were inception cohorts (studies recruiting only patients at or near diagnosis) [5,11,12,16,19] and nine were non-inception cohorts (e.g. prevalence studies, consecutive series) [10, 13-15, 17, 18, 20-22].…”

Section: Included Studiesmentioning

confidence: 99%

A systematic review of loss of independence in Parkinson’s disease

2015

View full text Add to dashboard Cite

Functional dependency (needing help with basic ADLs) is an important outcome in Parkinson's disease (PD). "Death or dependency", as opposed to being alive and independent, is a useful dichotomous indicator of poor outcome. We aimed to systematically review the progression to dependency in PD and what factors predicted development of dependency. Comprehensive searches were performed to identify observational studies of dependency in PD with follow-up of at least 3 years. Other forms of parkinsonism and highly selected cohorts were excluded. Descriptive analysis of included studies was performed and outcomes over time were plotted by type of cohort (inception/non-inception). Independent prognostic factors were identified. There were insufficient data for meta-analysis. Of 15,154 unique references identified, 14 studies were included. Most studies were of low quality. There was heterogeneity in definitions of dependency and the measured risk of dependency at similar time-points. Risk of dependency in inception studies was about 10-25 % at 5 years and about 20-50 % at 10 years; and risk of "death or dependency" in the inception studies was about 15-40 % at 5 years and about 35-70 % at ten years. More bradykinesia and older age were associated with more dependency, but there was little evidence for other prognostic factors. Few high-quality data on dependency are available. Heterogeneity in study populations, methodology and outcome reporting made data synthesis difficult. Few prognostic factors have been identified. Further data from representative inception studies are necessary to better understand the progression of dependency in PD.

show abstract

Determinants of quality of life in Parkinson’s disease: a perspective of novel clinical subtypes

Fan

Zhang

Liang

et al. 2021

Ann Clin Transl Neurol

View full text Add to dashboard Cite

Objective New subtyping classification systems of Parkinson’s disease (PD) have been proposed for phenotyping patients into three different subtypes: mild motor‐predominant (PD‐MMP), intermediate (PD‐IM) and diffuse malignant (PD‐DM). The quality of life (QoL) underlying the novel PD clinical subtypes is unknown. This study aimed explore the feasibility of the classification in Chinese PD patients and to investigate the potential heterogeneous determinants of QoL among the three subtypes. Methods 298 PD patients were enrolled, including 129 PD‐MMP patients, 121 PD‐IM patients and 48 PD‐DM patients. All patients completed the QoL assessment, clinical evaluations and neuropsychological tests. Univariate linear analysis and multiple stepwise regression analysis were performed to identify determinants of QoL. Results Compared to PD‐MMP patients, PD‐IM and PD‐DM patients had more impaired QoL. The Geriatric Depression Rating Scale (GDS) score, Non‐Motor Symptoms Questionnaire (NMSQ) score, Unified Parkinson’s Disease Rating Scale part III (UPDRS‐III) score and Epworth Sleepiness Score (ESS) were independent contributors to QoL in PD‐MMP patients. The GDS score, ESS and sniffin’ sticks screening 12 test score were independent contributors to QoL in PD‐IM patients. The GDS score and Mini Mental State Examination score were independent contributors to QoL in PD‐DM patients. Interpretation The new novel subtyping classification is feasible for Chinese PD patients. Although depression was the most crucial determinant for QoL in PD‐MMP, PD‐IM and PD‐DM patients, the other contributors of QoL in the three subtypes were heterogeneous. These findings may prompt clinicians to target specific factors for improving QoL depending on PD subtypes.

show abstract

Prognostic factors of motor impairment, disability, and quality of life in newly diagnosed PD

Abstract: This study shows the importance of nondopaminergic symptoms at the time of diagnosis, because these symptoms are the main determinants of increased disability in the first 5 years of the disease.

Cited by 73 publications

References 29 publications

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

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

A systematic review of loss of independence in Parkinson’s disease

Determinants of quality of life in Parkinson’s disease: a perspective of novel clinical subtypes

Contact Info

Product

Resources

About