Pablo Martínez-Martín1, Carmen Rodríguez-Blázquez2, Tomoko Arakaki3, Víctor Campos Arillo4, Pedro Chaná5, William Fernández6, Nélida Garretto3, Juan Carlos Martínez-Castrillo7, Mayela Rodríguez-Violante8, Marcos Serrano-Dueñas9, Diego Ballesteros10, Jose Manuel Rojo-Abuin11, Kallol Ray Chaudhuri12, Marcelo Merello10. 1. National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain. Electronic address: pmartinez@isciii.es. 2. National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain. 3. Department of Neurology, Hospital Ramos Mejia, Buenos Aires, Centro Universitario de Neurología de la Universidad de Buenos Aires (UBA), Argentina. 4. Movement Disorders Unit, Department of Neuroscience, Hospital Xanit International, Benalmádena, Málaga, Spain. 5. CETRAM, Facultad de Ciencias Médicas Universidad de Santiago de Chile, Chile. 6. Movement Disorders Unit, Department of Neurology, Universidad Nacional de Colombia, Bogotá, Colombia. 7. Movement Disorders Unit, Department of Neurology, Hospital Ramon y Cajal, IRYCIS, Madrid, Spain. 8. Movement Disorders Unit, Instituto Nacional de Neurologia y Neurocirugia, Mexico, DF, Mexico. 9. Movement Disorder and Biostatistics Units, Neurological Service, Carlos Andrade Marín Hospital and Medicine Faculty, Pontifical Catholic University of Ecuador, Quito, Ecuador. 10. Movement Disorders Section, Raul Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina. 11. Department of Statistics, Centre of Human and Social Sciences, Spanish Council for Scientific Research, Madrid, Spain. 12. National Parkinson Foundation International Centre of Excellence, King's College Hospital, King's College, London.
Abstract
BACKGROUND: Severity of PD is usually assessed by means of the motor and disability-based Hoehn and Yahr staging (HY), or clinician and patient global perceptions. Scores of more detailed assessments, as the MDS-UPDRS, have not been translated to a grading that allows assignment of score sections to severity levels. The objective of the present study is to determine cut-off points for PD severity levels based on the MDS-UPDRS. METHODS: International, observational study. Applied assessments were: HY, MDS-UPDRS, Clinical Impression for Severity Index, and Clinical and Patient Global Impression of Severity. The coincidence in severity level (mild, moderate, severe) of at least two clinical classifications plus the patient's gradation was considered "the criterion of severity". Cut-off values for each MDS-UPDRS subscale was determined by triangulation of: 1) percentile 90 of the subscale total score; 2) receiver operating characteristic (ROC) analysis; and 3) ordinal logistic regression (OLR) model. RESULTS: Sample was composed of 452 consecutive PD patients without dementia, 55.3% males, age 65.1 ± 10.7 years and PD duration 8.7 ± 6.3 years. All HY stages were represented. The "criterion", classified 275 patients (60.8% of the sample) as: mild PD, 149 (54.2%); moderate, 82 (29.8%); and severe, 44 (16%). The following MDS-UPDRS cut-off points between mild/moderate and moderate/severe levels were found: 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. CONCLUSION: Cut-off points to classify PD patients as mild, moderate, or severe on the basis of their MDS-UPDRS scores are proposed.
BACKGROUND: Severity of PD is usually assessed by means of the motor and disability-based Hoehn and Yahr staging (HY), or clinician and patient global perceptions. Scores of more detailed assessments, as the MDS-UPDRS, have not been translated to a grading that allows assignment of score sections to severity levels. The objective of the present study is to determine cut-off points for PD severity levels based on the MDS-UPDRS. METHODS: International, observational study. Applied assessments were: HY, MDS-UPDRS, Clinical Impression for Severity Index, and Clinical and Patient Global Impression of Severity. The coincidence in severity level (mild, moderate, severe) of at least two clinical classifications plus the patient's gradation was considered "the criterion of severity". Cut-off values for each MDS-UPDRS subscale was determined by triangulation of: 1) percentile 90 of the subscale total score; 2) receiver operating characteristic (ROC) analysis; and 3) ordinal logistic regression (OLR) model. RESULTS: Sample was composed of 452 consecutive PDpatients without dementia, 55.3% males, age 65.1 ± 10.7 years and PD duration 8.7 ± 6.3 years. All HY stages were represented. The "criterion", classified 275 patients (60.8% of the sample) as: mild PD, 149 (54.2%); moderate, 82 (29.8%); and severe, 44 (16%). The following MDS-UPDRS cut-off points between mild/moderate and moderate/severe levels were found: 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. CONCLUSION: Cut-off points to classify PDpatients as mild, moderate, or severe on the basis of their MDS-UPDRS scores are proposed.
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