The Movement Disorder Society Nonmotor Rating Scale: Initial Validation Study

Abstract

Background The Movement Disorder Society–sponsored Nonmotor Rating Scale is an update of the existing Parkinson's disease Nonmotor Symptoms Scale modified to address some limitations in Nonmotor Symptoms Scale scoring, structure, and symptom coverage. Methods PD patients were recruited from movement disorder centers in an international, multicenter study. The Movement Disorder Society Nonmotor Rating Scale, consisting of 13 domains plus a subscale for nonmotor fluctuations, was rater administered, along with the Nonmotor Symptoms Scale and other clinical assessments. Standard reliability and validity testing were conducted. Results Four hundred and two PD patients were recruited (mean age ± standard deviation, 67.42 ± 9.96 years; mean age at PD onset ± standard deviation, 59.27 ± 10.67 years; median Hoehn and Yahr stage 2 (interquartile range 2–3). Data quality was satisfactory for all Movement Disorder Society Nonmotor Rating Scale domains except sexual (6.7% missing data). There were no floor or ceiling effects for the Movement Disorder Society Nonmotor Rating Scale and nonmotor fluctuations total score; domains had no ceiling effects, but some floor effects (13.5%–83.5%). The Movement Disorder Society Nonmotor Rating Scale and nonmotor fluctuations total score internal consistency were acceptable (average Cronbach's alpha, 0.66 and 0.84, respectively); interrater reliability was excellent (intraclass correlation coefficient, >0.95); for test‐retest reliability, the intraclass correlation coefficient was 0.84 for the Movement Disorder Society Nonmotor Rating Scale and 0.70 for Movement Disorder Society nonmotor fluctuations total score, and precision was excellent for the Movement Disorder Society Nonmotor Rating Scale (standard error of measurement, 25.30) and fair for nonmotor fluctuations (standard error of measurement, 7.06). Correlations between Movement Disorder Society Nonmotor Rating Scale score and the corresponding Nonmotor Symptoms Scale and Movement Disorder Society UPDRS scores were high. There were no significant sex or age effects. The Movement Disorder Society Nonmotor Rating Scale score increased with increasing PD duration, disease severity, and PD medication dose (all P < 0.001). Conclusions The Movement Disorder Society Nonmotor Rating Scale is a valid measure for measuring the burden of a wide range of Nonmotor Rating Scale scores, including nonmotor fluctuations, in PD patients. © 2019 International Parkinson and Movement Disorder Society

Alexithymia Is Associated with Reduced Quality of Life and Increased Caregiver Burden in Parkinson’s Disease

“…Quality of life in PD is reduced in all disease stages. Contributing factors are motor and non-motor symptoms [ 6 , 9 , 28 , 38 , 39 , 40 ]. In the last decade, the influence of non-motor symptoms was extensively studied [ 41 ].…”

“…In the last decade, the influence of non-motor symptoms was extensively studied [ 41 ]. However, even during the last few years, several neglected non-motor symptoms have emerged or found new spotlights [ 26 , 40 , 42 ]. Our results support the role of alexithymia as a non-motor symptom contributing to impaired quality of life in PD.…”

Prevalence of Non‐Motor Symptoms and Non‐Motor Fluctuations in Parkinson's Disease Using the MDS‐NMS

“…The newly developed and validated Movement Disorders Society‐Nonmotor Rating Scale (MDS‐NMS) is an updated version of the NMSS and has been shown to be a reliable and valid instrument for assessing the burden of a broad variety of NMS, including non‐motor fluctuations (NMF) 20 . This rating scale is likely to serve as a global tool in clinical trials, global clinical registries, and epidemiological cohort studies in PD.…”

Unmet needs in Parkinson disease: Motor and non-motor

“…While clinic-based holistic identification of NMS in PD has been greatly aided by the development of specific tools, such as the NMS questionnaire (NMSQ) in 2006 [28][29][30] (Table 4) and the NMS Scale (NMSS) in 2007, awareness and under-reporting of NMS is rife across clinics in the world [28][29][30]. However, societal recognition of the role that NMS plays in PD patients and carers is rising and is exemplified by the activities of the Movement Disorders Society setting up the world's first PD non-motor study group as well as sponsoring the international validation of an updated version of the NMSS, called the MDS-NMS [31].…”