Clinical classification systems and long-term outcome in mid- and late-stage Parkinson’s disease

Abstract Parkinson’s disease shows a heterogeneous course and different clinical subtyping systems have been described. To compare the capabilities of two clinical classification systems, motor-phenotypes, and a simplified clinical motor-nonmotor subtyping system, a cohort was included at mean 7.9 ±...

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Autores principales:	Emil Ygland Rödström, Andreas Puschmann
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/893524f5226b4872a5f3c4e30b1a4eee
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spelling	oai:doaj.org-article:893524f5226b4872a5f3c4e30b1a4eee2021-12-02T17:06:26ZClinical classification systems and long-term outcome in mid- and late-stage Parkinson’s disease10.1038/s41531-021-00208-42373-8057https://doaj.org/article/893524f5226b4872a5f3c4e30b1a4eee2021-08-01T00:00:00Zhttps://doi.org/10.1038/s41531-021-00208-4https://doaj.org/toc/2373-8057Abstract Parkinson’s disease shows a heterogeneous course and different clinical subtyping systems have been described. To compare the capabilities of two clinical classification systems, motor-phenotypes, and a simplified clinical motor-nonmotor subtyping system, a cohort was included at mean 7.9 ± 5.3 years of disease duration, classified using both clinical systems, and reexamined and reclassified at the end of an observation period. Time-points were retrospectively extracted for five major disease milestones: death, dementia, Hoehn and Yahr stage 5, nursing home living, and walking aid use. Eighty-nine patients were observed for 8.1 ± 2.7 years after inclusion. Dementia developed in 32.9% of the patients and 36.0–67.4% reached the other milestones. Motor-phenotypes were unable to stratify risks during this period, but the worst compared with the more favorable groups in the motor-nonmotor system conveyed hazard ratios between 2.6 and 63.6 for all milestones. A clear separation of risks for dying, living at the nursing home, and reaching motor end-stage was also shown when using only postural instability and gait disorder symptoms, without weighing them against the severity of the tremor. At reexamination, 29.4% and 64.7% of patients had changed classification groups in the motor-phenotype and motor-nonmotor systems, respectively. The motor-nonmotor system thus stratified risks of reaching crucial outcomes in mid–late Parkinson’s disease far better than the well-studied motor-phenotypes. Removing the tremor aspect of motor-phenotypes clearly improved this system, however. Classifications in both systems became unstable over time. The simplification of the motor-nonmotor system was easily applicable and showed potential as a prognostic marker during a large part of Parkinson’s disease.Emil Ygland RödströmAndreas PuschmannNature PortfolioarticleNeurology. Diseases of the nervous systemRC346-429ENnpj Parkinson's Disease, Vol 7, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurology. Diseases of the nervous system RC346-429 Emil Ygland Rödström Andreas Puschmann Clinical classification systems and long-term outcome in mid- and late-stage Parkinson’s disease
description	Abstract Parkinson’s disease shows a heterogeneous course and different clinical subtyping systems have been described. To compare the capabilities of two clinical classification systems, motor-phenotypes, and a simplified clinical motor-nonmotor subtyping system, a cohort was included at mean 7.9 ± 5.3 years of disease duration, classified using both clinical systems, and reexamined and reclassified at the end of an observation period. Time-points were retrospectively extracted for five major disease milestones: death, dementia, Hoehn and Yahr stage 5, nursing home living, and walking aid use. Eighty-nine patients were observed for 8.1 ± 2.7 years after inclusion. Dementia developed in 32.9% of the patients and 36.0–67.4% reached the other milestones. Motor-phenotypes were unable to stratify risks during this period, but the worst compared with the more favorable groups in the motor-nonmotor system conveyed hazard ratios between 2.6 and 63.6 for all milestones. A clear separation of risks for dying, living at the nursing home, and reaching motor end-stage was also shown when using only postural instability and gait disorder symptoms, without weighing them against the severity of the tremor. At reexamination, 29.4% and 64.7% of patients had changed classification groups in the motor-phenotype and motor-nonmotor systems, respectively. The motor-nonmotor system thus stratified risks of reaching crucial outcomes in mid–late Parkinson’s disease far better than the well-studied motor-phenotypes. Removing the tremor aspect of motor-phenotypes clearly improved this system, however. Classifications in both systems became unstable over time. The simplification of the motor-nonmotor system was easily applicable and showed potential as a prognostic marker during a large part of Parkinson’s disease.
format	article
author	Emil Ygland Rödström Andreas Puschmann
author_facet	Emil Ygland Rödström Andreas Puschmann
author_sort	Emil Ygland Rödström
title	Clinical classification systems and long-term outcome in mid- and late-stage Parkinson’s disease
title_short	Clinical classification systems and long-term outcome in mid- and late-stage Parkinson’s disease
title_full	Clinical classification systems and long-term outcome in mid- and late-stage Parkinson’s disease
title_fullStr	Clinical classification systems and long-term outcome in mid- and late-stage Parkinson’s disease
title_full_unstemmed	Clinical classification systems and long-term outcome in mid- and late-stage Parkinson’s disease
title_sort	clinical classification systems and long-term outcome in mid- and late-stage parkinson’s disease
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/893524f5226b4872a5f3c4e30b1a4eee
work_keys_str_mv	AT emilyglandrodstrom clinicalclassificationsystemsandlongtermoutcomeinmidandlatestageparkinsonsdisease AT andreaspuschmann clinicalclassificationsystemsandlongtermoutcomeinmidandlatestageparkinsonsdisease
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Clinical classification systems and long-term outcome in mid- and late-stage Parkinson’s disease

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