Task force report on scales to assess dyskinesia in Parkinson's disease: Critique and recommendations

Abstract

Drug-induced dyskinesia is a common phenomenon in Parkinson's disease (PD) and is often socially as well as physically disabling for patients. The Movement Disorders Society commissioned a task force to assess available clinical rating scales, critique their clinimetric properties, and make recommendations regarding their clinical utility. A task force composed six clinical researchers who systematically searched the literature for scales measuring dyskinesia in PD, evaluated the scales' previous use, performance parameters, and quality of validation data (if available). A scale was designated "Recommended" if the scale has been used in clinical studies beyond the group that developed it, has been specifically used in PD reports, and if clinimetric studies have established that it is a valid, reliable, and sensitive. "Suggested" scales met two of the above criteria and those meeting one were "Listed." Based on the systematic review, eight rating scales for dyskinesia that have either been validated or used in PD were identified. These were the Abnormal Involuntary Movement Scale (AIMS), The Unified Parkinson's Disease Rating Scale (UPDRS) part IV, the Obeso Dyskinesia Rating Scale, the Rush Dyskinesia Rating Scale, the Clinical Dyskinesia Rating Scale (CDRS), the Lang-Fahn Activities of Daily Living Dyskinesia Scale, the Parkinson Disease Dyskinesia Scale (PDYS-26), and the Unified Dyskinesia Rating Scale (UDysRS). Based on this review, at present two of the reviewed dyskinesia scales (AIMS and the Rush Dyskinesia Rating Scale) fulfill criteria for Recommended for use in PD populations, albeit weakly so; all of the remaining met criteria to be Suggested. However, the two most recent scales (PDYS-26 and UDysRS) have excellent clinimetric properties and appear to provide a reliable and valid assessment tool of dyskinesia in PD. If they are used successfully beyond the groups that developed them, both have the potential to be re-ranked as Recommended. As further testing of these scales in PD is warranted, no new scales are needed until the available scales are fully tested clinimetrically.

Targeting Striatal Metabotropic Glutamate Receptor Type 5 in Parkinson`s Disease: Bridging Molecular Studies and Clinical Trials

“…Thus, in the studies carried out by Berg et al However, several methodological problems arise from using these PD scales to measure dyskinesia, which have been well described elsewhere [111]. For instance, as mentioned above, the short duration of these clinical trials, or importantly the lack of a fully validation of some scales (i.e.…”

Treatment of Parkinson's Disease: What's in the Non-dopaminergic Pipeline?

“…Determination of on/off fluctuations relies on patient diaries, which may be subject to variability despite appropriate training. Also, while there are multiple dyskinesia rating scales [130], the clinical variability in the types of dyskinesias and their timing offers challenges in quantifying response to treatment. There is similarly a need to define the most appropriate outcome measures for trials focusing on PD gait symptoms.…”

Facing the Unique Challenges of Dyskinesias In Parkinson‘s Disease

“…RDRS and MDS-UPDRS also include rater's evaluation of dyskinesia-induced disability. However, none of these scales were sufficiently comprehensive to cover all pertinent aspects of dyskinesia rating [105]. In an effort to develop a comprehensive tool for assessment of dyskinesia, UDysRS was recently developed [106].…”

“…In an effort to develop a comprehensive tool for assessment of dyskinesia, UDysRS was recently developed [106]. This scale includes all pertinent aspects related to the evaluation of dyskinesia including patient perceptions, impairment, disability, anatomic distribution and phenomenology and has been clinimetrically tested in a variety of programs [105].…”