Abstract
Background and objective: Parkinson’s disease (PD) is a clinically heterogeneous disorder in which the symptoms and prognosis can be very different among patients. We propose a new simple classification to identify key symptoms and staging in PD. Patients and Methods: Sixteen movement disorders specialists from Spain participated in this project. The classification was consensually approved after a discussion and review process from June to October 2021. The TNM classification and the National Institutes of Health Stroke Scale (NIHSS) were considered as models in the design. Results: The classification was named MNCD and included 4 major axes: (1) motor symptoms; (2) non-motor symptoms; (3) cognition; (4) dependency for activities of daily living (ADL). Motor axis included 4 sub-axes: (1) motor fluctuations; (2) dyskinesia; (3) axial symptoms; (4) tremor. Four other sub-axes were included in the non-motor axis: (1) neuropsychiatric symptoms; (2) autonomic dysfunction; (3) sleep disturbances and fatigue; (4) pain and sensory disorders. According to the MNCD, 5 stages were considered, from stage 1 (no disabling motor or non-motor symptoms with normal cognition and independency for ADL) to 5 (dementia and dependency for basic ADL). Conclusions: A new simple classification of PD is proposed. The MNCD classification includes 4 major axes and 5 stages to identify key symptoms and monitor the evolution of the disease in patients with PD. It is necessary to apply this proof of concept in a properly designed study.
Highlights
Parkinson’s disease (PD) is a complex disorder with a wide variety of symptoms that have a negative impact on patients’ quality of life (QoL) and independence for activities of daily living (ADL) [1]
It is necessary to apply this proof of concept in a properly designed study
PD is clinically heterogeneous, since symptoms and prognosis can be very different among patients [2], so that having a simple classification, which could properly inform about key symptoms at different stages of the disease, would be of great importance
Summary
Parkinson’s disease (PD) is a complex disorder with a wide variety of symptoms that have a negative impact on patients’ quality of life (QoL) and independence for activities of daily living (ADL) [1]. PD is clinically heterogeneous, since symptoms and prognosis can be very different among patients [2], so that having a simple classification, which could properly inform about key symptoms at different stages of the disease, would be of great importance. The importance of non-motor symptoms (NMS) has increased over the last years because they are frequent and disabling, and impact negatively on patients’ QoL independently of other variables [5]. A new classification combining the H&Y and the non-motor symptoms scale (NMSS) has been suggested [6]. According to this scale (H&Y-NMSS), patients with a greater global NMS burden but a lower H&Y stage can have a worse QoL than patients with a higher H&Y stage but a lower NMS burden [7]. The TNM classification and the National Institutes of Health Stroke Scale (NIHSS) were considered as models in the design
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