Comprehensive grading of Parkinson’s disease using motor and non-motor assessments: addressing a key unmet need

ABSTRACT

Introduction: Parkinson’s disease (PD) is expressed through motor and non-motor symptoms (NMS) that differ considerably in presence and severity among patients and over time. Furthermore, the progression pattern of the NMS does not necessarily parallel the course of the motor impairment. Gradation of PD according to the motor impairment and burden of NMS is an unmet need for an appropriate management of patients.

Areas covered: A review of the studies on clinical gradation methods applied to PD is carried out in this article. Studies have provided cut-off values for a pragmatic classification of scores from rating scales and questionnaires in mild, moderate, and severe PD, considering motor state, complications, disability, and NMS. Grading systems with Hoehn and Yahr staging, Clinical Impression of Severity Index for PD, NMS Scale, NMS Questionnaire, and MDS-UPDRS, are available. These systems are reviewed in detail and examples in format of simple cards are presented.

Expert commentary: Patients can be adequately assessed and properly managed according to their specific needs. A comprehensive method for gradation of PD manifestations severity is, therefore, desirable. In the absence of objective in vivo biomarkers for quantitative standardized information, scale-based clinical gradation systems provide a suitable alternative.

KEYWORDS:

• Parkinson’s disease
• gradation
• severity
• assessment
• Hoehn and Yahr scale
• Clinical Impression of Severity Index for Parkinson’s Disease
• Non-Motor Symptoms Scale
• Non-Motors Symptoms Questionnaire
• MDS-UPDRS

Declaration of interest

P Martinez-Martin has received honoraria from Editorial Viguera, Movement Disorder Society, AbbVie, and UCB; has served on the UCB advisory Board; and has received a grant from the International Parkinson and Movement Disorder Society. KR Chaudhuri has served as Editor-in-Chief for Nature Parkinson, as editor for Basal Ganglia; receives publishing royalties from ‘Non-motor symptoms of Parkinson’s Disease,’ Oxford University Press, 2nd edition, 2014, 1st edition, 2011; has received honoraria from Parkinson’s UK, NIHR, the International Parkinson and Movement Disorder Society, Parkinson’s EU, UCB, AbbVie, Britannia, US WorldMeds, Otsuka, Medtronic, and Zambon; has served as a consultant for AbbVie, UCB, Britannia, Medtronic, Mundipharma; has served on the advisory Board from Mundipharma and Eli Lily; has received research grants from Britanna, UCB, the National Institute of Health Research, and Parkinson’s UK; has received support from the H 2016-2018: Horizon 2020 award, i-PROGNOSIS: Intelligent Parkinson early detection guiding novel supportive Interventions, 2015-2016: CRN South London contingency funding, and 2014-2016: International Parkinson’s and Movement Disorders Society: Field Validation of the MDS-NMS Scale; and he currently receives licence fee payments from the KPP scale and the PDSS-2 scale. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.