Comparison of two motor subtype classifications in de novo Parkinson's disease

Choi, Seong-Min; Kim, Byeong C.; Cho, Bang‐Hoon; Kang, Kyung Wook; Choi, Kang‐Ho; Kim, Joon‐Tae; Lee, Seung-Han; Park, Man‐Seok; Kim, Myeong-Kyu; Cho, Ki-Hyun

doi:10.1016/j.parkreldis.2018.04.021

Cited by 26 publications

(14 citation statements)

References 26 publications

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“…However, only patients with the PIGD/p-PIGD subtypes showed more severe NMSs than the patients with the TD/p-TD subtypes. Hence, compared with the other two classifications, the TD/mixed/AR subgroups may be unsuitable for identifying NMSs of PD patients, which is consistent with previous research results (14). Furthermore, differences in the NMSQuest domains between patients in the p-TD/p-PIGD classification were similar to those in the patients in the TD/indeterminate/PIGD classification.…”

Section: Discussionsupporting

confidence: 87%

“…A recent study compared two motor subtype classifications of de novo PD patients and found that the TD/indeterminate/PIGD subtype classification appeared to be more likely to detect NMSs than the TD/mixed/AR phenotypes (14). Nevertheless, comparisons of three motor subtype classifications with de novo PD patients have not been examined previously.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Three Motor Subtype Classifications in de novo Parkinson's Disease Patients

Ren

Hua

et al. 2020

Front. Neurol.

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Objective: The aims of this study were to compare the characteristics of three motor subtype classifications in patients with de novo Parkinson's disease (PD) and to find the most suitable motor subtype classification for identifying non-motor symptoms (NMSs).Methods: According to previous studies, a total of 256 patients with de novo PD were classified using the tremor-dominant/mixed/akinetic-rigid (TD/mixed/AR), TD/indeterminate/postural instability and gait disturbance (PIGD), and predominantly TD/predominantly PIGD (p-TD/p-PIGD) classification systems.Results: Among the TD/mixed/AR subgroups, the patients with the AR subtype obtained more severe motor scores than the patients with the TD subtype. Among the TD/indeterminate/PIGD subgroups and between the p-TD and p-PIGD subgroups, the patients with the PIGD/p-PIGD subtype obtained more severe scores related to activities of daily living (ADL), motor and non-motor symptoms, including depression, anxiety, and sleep impairment, than the patients with the TD/p-TD subtype. Furthermore, symptoms in the cardiovascular, gastrointestinal, and miscellaneous domains of the Non-motor Questionnaire (NMSQuest) were more prevalent in the patients with the PIGD/p-PIGD subtypes than the patients with the TD/p-TD subtypes.Conclusions: The PIGD/p-PIGD subtypes had more severe ADL, motor and non-motor symptoms than the TD/p-TD subtypes. We disclosed for the first time that the TD/indeterminate/PIGD classification seems to be the most suitable classification among the three motor subtype classifications for identifying NMSs in PD.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Comparison of Three Motor Subtype Classifications in de novo Parkinson's Disease Patients

Ren

Hua

et al. 2020

Front. Neurol.

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“…PIGD and TD are two typical motor subtypes of PD. A number of studies have demonstrated that certain non-motor symptoms differ among these two subtypes as well as the subtype in between (3,7,(22)(23)(24). Our results of SCOPA-AUT, orthostatic hypotension, and absent SSR reveal such a differential presence, with the worst indices being in the PIGD subtype.…”

Section: Discussionmentioning

confidence: 47%

Association Analyses of Autonomic Dysfunction and Sympathetic Skin Response in Motor Subtypes of Parkinson's Disease

Wang

Liu

et al. 2020

Front. Neurol.

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Introduction: Autonomic dysfunction is a common and disabling non-motor symptom of Parkinson's disease (PD). We aimed to understand autonomic dysfunction in PD motor subtypes, the pattern of sympathetic skin response (SSR) to motor asymmetry, and the association of SSR with autonomic and motor dysfunctions. Methods: A total of 101 PD patients of Han Chinese were included. Unified PD rating scale (UPDRS), scales for outcomes in PD-autonomic symptoms (SCOPA-AUT), orthostatic hypotension, and SSR were evaluated. Results: SCOPA-AUT and incidences of orthostatic hypotension and absent SSR were worse in the subtype of postural instability gait disorder (PIGD) than the subtypes of tremor dominant and intermediate. SSR latency and amplitude were asymmetrical corresponding to the accentuation of motor severity. Patients with absent SSR had worse UPDRS and SCOPA-AUT scores. SSR parameters of the severe side in patients with SSR showed no independent association with the scores. Conclusion: Our results support that autonomic dysfunction is more severe in the PIGD than other subtypes and demonstrate an asymmetry of SSR in PD patients. Absent SSR may indicate worse autonomic and motor symptoms, but SSR parameters are not sufficient to evaluate the severity of the dysfunctions.

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“…Classification of PD subtypes is based on empirical clinical observations of prominent motor symptoms. At present, the recognized PD motor subtype classifications, including tremordominant/indeterminate/postural instability and gait difficulty (TD/indeterminate/PIGD) put forward by Jankovic and two classifications of the TD/mixed/akinetic-rigid (AR) classification system proposed by Schiess and Kang (Jankovic et al, 1990;Schiess et al, 2000;Kang et al, 2005), are widely used (Guan et al, 2017;Choi et al, 2018;Erro et al, 2019;Lian et al, 2019;Polychronis et al, 2019;Ren et al, 2020a,b). Although numerous additional subtypes based on data-driven approaches have been subsequently proposed (Graham and Sagar, 1999;van Rooden et al, 2010;Fereshtehnejad et al, 2015), the above three classifications occupy a dominant position in clinical practice and scientific research and have entered the conventional lexicon of clinicians.…”

Section: Introductionmentioning

confidence: 99%

Consistency and Stability of Motor Subtype Classifications in Patients With de novo Parkinson’s Disease

Ren

Pan

et al. 2021

Front. Neurosci.

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ObjectivePatients with Parkinson’s disease (PD) are commonly classified into subtypes based on motor symptoms. The aims of the present study were to determine the consistency between PD motor subtypes, to assess the stability of PD motor subtypes over time, and to explore the variables influencing PD motor subtype stability.MethodsThis study was part of a longitudinal study of de novo PD patients at a single center. Based on three different motor subtype classification systems proposed by Jankovic, Schiess, and Kang, patients were respectively categorized as tremor-dominant/indeterminate/postural instability and gait difficulty (TD/indeterminate/PIGD), TDS/mixedS/akinetic-rigidS (ARS), or TDK/mixedK/ARK at baseline evaluation and then re-assessed 1 month later. Demographic and clinical characteristics were recorded at each evaluation. The consistency between subtypes at baseline evaluation was assessed using Cohen’s kappa coefficient (κ). Additional variables were compared between PD subtype groups using the two-sample t-test, Mann–Whitney U-test or Chi-squared test.ResultsOf 283 newly diagnosed, untreated PD patients, 79 were followed up at 1 month. There was fair agreement between the Jankovic, Schiess, and Kang classification systems (κS = 0.383 ± 0.044, κK = 0.360 ± 0.042, κSK = 0.368 ± 0.038). Among the three classification systems, the Schiess classification was the most stable and the Jankovic classification was the most unstable. The non-motor symptoms questionnaire (NMSQuest) scores differed significantly between PD patients with stable and unstable subtypes based on the Jankovic classification (p = 0.008), and patients with a consistent subtype had more severe NMSQuest scores than patients with an inconsistent subtype.ConclusionFair consistency was observed between the Jankovic, Schiess, and Kang classification systems. For the first time, non-motor symptoms (NMSs) scores were found to influence the stability of the TD/indeterminate/PIGD classification. Our findings support combining NMSs with motor symptoms to increase the effectiveness of PD subtypes.

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Comparison of two motor subtype classifications in de novo Parkinson's disease

Cited by 26 publications

References 26 publications

Comparison of Three Motor Subtype Classifications in de novo Parkinson's Disease Patients

Comparison of Three Motor Subtype Classifications in de novo Parkinson's Disease Patients

Association Analyses of Autonomic Dysfunction and Sympathetic Skin Response in Motor Subtypes of Parkinson's Disease

Consistency and Stability of Motor Subtype Classifications in Patients With de novo Parkinson’s Disease

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