Rating Segmental Progression of Cardinal Motor Symptoms in Early Parkinson's Disease
Rapid Response Innovation Awards, 2014
We recently reported a new, practical approach to rate segmental progression of cardinal motor symptoms in Parkinson's disease (PD) at early stages. We computed four new scores ó the Bradykinesia Segmental Score, the Tremor Segmental Score, the Rigidity Segmental Score and the Combined Segmental Score óevaluating the anatomical spread of the cardinal motor symptoms of PD on the five body segments. In detail, the Combined Segmental Score was sensitive in detecting changes in disease progression of treated PD patients in short-term follow up. Aim of this study is to verify if the scores we proposed are valid tools in detecting motor progression in a large cohort of both treated and untreated PD patients in the early stage of disease as compared to both the Hoehn and Yahr and the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III). †
This study uses data available from participants in the MJFF-sponsored Parkinsonís Progression Markers Initiative (PPMI). We will compute the Bradykinesia Segmental Score, the Tremor Segmental Score, the Rigidity Segmental Score and the Combined Segmental Score from MDS-UPDRS-III of PD patients enrolled in the PPMI study up to 12-month follow-up visit since the screening visit.
Relevance to Diagnosis/Treatment of Parkinsonís Disease: † † † † † † † † † ††
To date, clinical instruments able to detect short-term progression in the very early stage of disease are lacking. Thus, the real benchmark of our study will be to demonstrate that our scores are a useful complement to current rating tools in clinically detecting progression of motor symptoms, in a large population of both untreated and treated PD patients.
Anticipated Outcome: † † † † †
When disease-modifying drugs are available, it will be crucial both to involve patients in the earliest phase of disease in clinical trials and to have instruments able to detect short-term progression of the disease. Thus, developing strategies efficacious in detecting short-term progression of motor features in PD at early stage is an urgent unmet need. This study aims to identify clinical tools able to detect motor progression.
We demonstrated that our new approach rating segmental progression of cardinal symptoms of PD is able in detecting changes in disease progression of both treated and untreated PD patients since the earliest stages of disease. When performing a direct comparison, our scores presented a faster decline as compared to the classical PD staging (i.e. H&Y), possibly suggesting that they better represent disease progression and the spread of the motor symptoms over the five body segments. Furthermore, our segmental scores presented a trend towards significance for a relationship with imaging data evaluating the dopaminergic degeneration, better reflecting the progressive underlying pathological degeneration rather than the classical PD motor scores in the earliest stages of the diseases. Finally, we demonstrated that the segmental scores present a relationship with disability in the activities of daily living and show different features according to motor phenotype. We suggest that our approach evaluating the segmental spread of motor symptoms maybe be an useful complementary approach to rate PD progression in the earliest stages of the disease.
Full Professor in Neurology at Department of Medicine and Surgery, Center for Neurodegenerative Diseases, University of Salerno
Location: Salerno, Italy
Researcher at Center for Neurodegenerative Diseases; University of Salerno
Location: Salerno, Italy