Stability of MDS-UPDRS Motor Subtypes Over Three Years in Early Parkinson's Disease.

Autor:	Kohat AK; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore., Ng SYE; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore., Wong ASY; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore., Chia NSY; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore., Choi X; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore., Heng DL; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.; Duke-NUS Graduate Medical School, Singapore, Singapore., Li W; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore., Ng HL; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore., Chua ST; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore., Neo SXM; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore., Xu Z; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore., Tay KY; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.; Duke-NUS Graduate Medical School, Singapore, Singapore., Au WL; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.; Duke-NUS Graduate Medical School, Singapore, Singapore., Tan EK; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.; Duke-NUS Graduate Medical School, Singapore, Singapore., Tan LCS; Department of Neurology, National Neuroscience Institute, Singapore, Singapore.; Parkinson's Disease and Movement Disorders Centre (Parkinson Foundation's International Center of Excellence), National Neuroscience Institute, Singapore, Singapore.; Duke-NUS Graduate Medical School, Singapore, Singapore.
Jazyk:	angličtina
Zdroj:	Frontiers in neurology [Front Neurol] 2021 Sep 24; Vol. 12, pp. 704906. Date of Electronic Publication: 2021 Sep 24 (Print Publication: 2021).
DOI:	10.3389/fneur.2021.704906
Abstrakt:	Background: Various classifications have been proposed to subtype Parkinson's disease (PD) based on their motor phenotypes. However, the stability of these subtypes has not been properly evaluated. Objective: The goal of this study was to understand the distribution of PD motor subtypes, their stability over time, and baseline factors that predicted subtype stability. Methods: Participants ( n = 170) from two prospective cohorts were included: the Early PD Longitudinal Singapore (PALS) study and the National Neuroscience Institute Movement Disorders Database. Early PD patients were classified into tremor-dominant (TD), postural instability and gait difficulty (PIGD), and indeterminate subtypes according to the Movement Disorder Society's Unified PD Rating Scale (MDS-UPDRS) criteria and clinically evaluated for three consecutive years. Results: At baseline, 60.6% patients were TD, 12.4% patients were indeterminate, and 27.1% patients were PIGD subtypes ( p < 0.05). After 3 years, only 62% of patients in TD and 50% of patients in PIGD subtypes remained stable. The mean levodopa equivalent daily dose (LEDD) was higher in the PIGD subtype (276.92 ± 232.91 mg; p = 0.01). Lower LEDD [ p < 0.05, odds ratio (OR) 0.99, 95% confidence interval (CI): 0.98-0.99] and higher TD/PIGD ratios ( p < 0.05, OR 1.77, 95% CI: 1.29-2.43) were independent predictors of stability of TD subtype with an area under the curve (AUC) of 0.787 (95%CI: 0.669-0.876), sensitivity = 57.8%, and specificity = 89.7%. Conclusion: Only 50-62% of PD motor subtypes as defined by MDS-UPDRS remained stable over 3 years. TD/PIGD ratio and baseline LEDD were independent predictors for TD subtype stability over 3 years. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Kohat, Ng, Wong, Chia, Choi, Heng, Li, Ng, Chua, Neo, Xu, Tay, Au, Tan and Tan.)
Databáze:	MEDLINE
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