Society-Unified Parkinson's Disease Rating Research Articles

TranSMART Foundation Datathon 1.0: The cross neurodegenerative diseases challenge

The tranSMART Foundation's inaugural Datathon took place June 30–July 2 at the Thomson Reuters offices in Boston, MA. The overall aim of the Datathon was to determine the feasibility of using the tranSMART platform to explore multiple large datasets on a customized cloud server to support a Datathon that could generate new research findings. The goal of this Datathon was to identify similarities and differences across different neurodegenerative diseases, specifically Alzheimer's disease and Parkinson's disease, and to discover new insights into these diseases. Specific objectives were to identify: • Common biomarker changes across Parkinson and Alzheimer disease • Common pathway changes across Parkinson and Alzheimer disease • The normal distribution of imaging and fluid biomarkers across controls • Novel hypotheses, research findings or conclusions about these neurodegenerative diseases. 2. Design The tranSMART Foundation, the Michael J. Fox Foundation, the University of Luxembourg and the University of Michigan worked together with the Laboratory of Neuro Imaging (LONI) to install tranSMART v1.2.4 on cloud servers at LONI, and to install the 14 datasets to be used for the Datathon. The ADNI, PPMI, LRRK2 and BioFIND datasets were curated and loaded by Thomson Reuters, working with the Michael J. Fox Foundation. Due to restrictions on access to and redistribution of the ADNI, PPMI, LRRK2 and BioFIND datasets, data use agreements were executed with the Alzheimer's Data Neuroimaging Initiative, the Parkinson's Progression Markers Initiative, the LRRK2 dataset, led by the Michael J. Fox foundation, and the BIOFIND dataset. Ten datasets that were curated and loaded by the University of Luxembourg originated in GEO, and did not require any data use agreements. This Datathon marked the first time that these datasets have been made available in a single analytic platform. Together the datasets represent over $500 million investment in data generation. ADNI: The Alzheimer's Disease Neuroimaging Initiative (ADNI) is a longitudinal, multicenter study to develop genetic, biochemical, clinical, and imaging biomarkers for the early detection and progression tracking of Alzheimer's disease. 3142 patients are currently enrolled. PPMI: The Parkinson's Progression Markers Initiative is a longitudinal, multimodal observational study of a large patient population. The dataset contains biological sampling, advanced imaging, clinical and behavioral assessments; i.e. the Movement Disorder Society—Unified Parkinson's Disease Rating Scales (MD-UPDRS), Montreal Cognitive Assessment (MoCA) and the University of Pennsylvania Smell Identification (UPSIT). 1334 patients are currently enrolled. LRRK2: Michael J. Fox Foundation has established a LRRK2 Cohort Consortium to undertake an innovative approach to design and streamline drug development around the LRRK2 gene, a promising target. 2824 patients are currently enrolled. BIOFIND: is a clinical observational study designed to discover and validate novel biomarkers for Parkinson's disease. 229 patients are currently enrolled. 10 Parkinson's Disease (PD) studies from GEO: The NCBI Gene Expression Omnibus (GEO—http://www.ncbi.nlm.nig.gov/). In attempt to exact valuable knowledge, data scientists from the Luxembourg Centre for Systems Biomedicine (http://wwwen.uni.lu/lcsb), University of Luxembourg (http://wwwen.uni.lu) manually curated 10 PD studies from GEO, which are selected based on having good amount of clinical data apart from gene expression data. These studies were curated in the context of ongoing Innovative Medicine Initiate (IMI) project and eTRIKS (http://www.etriks.org). Data from these studies were passed through following workflow: data acquisition, parsing, manual inspections, data standardization, semantic alignment and mapping, the generated structured files are ready to be used as input for the tranSMART ETL (Extraction, Transformation and Loading) operations. The structured files were loaded into tranSMART using the Pentaho Kettle ETL scripts. The tranSMART Foundation, working with the University of Michigan and LONI, installed the platform on LONI cloud servers, and coordinated the installation of the curated datasets onto these servers with Thomson Reuters, the Michael J. Fox Foundation and the University of Luxembourg. The latest tranSMART platform, v1.2.4, was employed for these efforts. Access to the databases permitted participants to evaluate whether modifications were needed to make the data more usable. Twenty-five scientists from leading institutions in the US and Europe were selected from a pool of over seventy applicants five teams.1 In addition to the tranSMART platform, various third-party analytic tools were employed, including MetaCore™, R interface, Spotfire, E-Workbook, MatLab, and REFS™.

Socioeconomic Status May Impact Functional Outcome of Deep Brain Stimulation Surgery in Parkinson's Disease.

To investigate the association between socioeconomic status and deep brain stimulation (DBS) outcomes in Parkinson's disease (PD). We analyzed a cohort of PD patients who underwent DBS from 2007 to 2011, who had Clinical Global Impression Scale-Improvement subscale (CGI-I) scores at approximately one year postsurgery. We also analyzed a subgroup of patients who had pre and postoperative Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part II (functional subscale) and European Quality of Life Scale (EQ5D) scores. We performed regression analyses to determine the association between their median household income and their improvement in the MDS-UPDRS Part II, EQ-5D, and CGI-I post-DBS surgery. We analyzed 125 PD patients with CGI-I at one year post-DBS, including a subset of 43 patients who had pre- and post-DBS MDS-UPDRS Part II and EQ5D scores at 6 and 12 months. Median income was not significantly associated with the one-year CGI-I, the six-month MDS-UPDRS II, and the six-month and one-year EQ5D score. However, after adjusting for preoperative MDS-UPDRS II score, for every $10,000 increase in household median income, there was a 2.15-point improvement on the MDS-UPDRS II score after one year (95% confidence interval = -3.63 to -0.66, p = 0.0060). PD patients with higher household incomes had better functional improvement at one year. However, this did not necessarily translate to better quality of life or overall clinical improvement when compared with PD patients with lower household incomes. The influence of household income on DBS and other advanced therapies for PD will need further investigation.

Relationship between the non-motor items of the MDS–UPDRS and Quality of Life in patients with Parkinson's disease

The Movement Disorder Society–Unified Parkinson's Disease Rating Scale (MDS–UPDRS) is a newly developed comprehensive tool to assess Parkinson's disease (PD), which covers a wider range of non-motor PD manifestations than the original UPDRS scale. The aim of this study was to assess the relationship between the MDS–UPDRS and Quality of Life (QoL) and to analyze the relationship between individual MDS–UPDRS non-motor items and QoL.A total of 291 PD patients were examined in a multicenter Slovak study. Patients were assessed by the MDS–UPDRS, HY scale and PDQ39. Data were analyzed using the multiple regression analyses.The mean participant age was 68.0±9.0years, 53.5% were men, mean disease duration was 8.3±5.3years and mean HY was 2.7±1.0. In a multiple regression analysis model the PDQ39 summary index was related to MDS–UPDRS parts II, I and IV respectively, but not to part III. Individual MDS–UPDRS non-motor items related to the PDQ39 summary index in the summary group and in the non-fluctuating patients subgroup were pain, fatigue and features of dopamine dysregulation syndrome (DDS). In the fluctuating PD patient subgroup, PDQ39 was related to pain and Depressed mood items. Other MDS–UPDRS non-motor items e.g. Anxious mood, Apathy, Cognitive impairment, Hallucinations and psychosis, Sleep problems, Daytime sleepiness and Urinary problems were related to some PDQ39 domains.The overall burden of NMS in PD is more important in terms of QoL than motor symptoms. Individual MDS–UPDRS non-motor items related to worse QoL are especially pain and other sensations, fatigue and features of DDS.

Motor phenotype of LRRK2-associated Parkinson's disease: a Tunisian longitudinal study.

Mutations in the leucine-rich repeat kinase 2 gene (LRRK2) were found to be a significant cause of late-onset autosomal dominant forms of Parkinson's disease (PD). To determine the motor characteristics of LRRK2-related disease, we conducted a longitudinal study of 58 G2019S LRRK2-associated PD patients and compared them with genetically undefined (GU) PD patients. Fifty-eight patients diagnosed with PD-related LRRK2 G2019S mutation were included in the study and compared with 54 sporadic PD patients with negative tests for LRRK2 G2019S, PINK1, SNCA, PRKN, and DJ1 mutations. Patients were assessed at baseline and after a follow-up period of 6 years. The Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), the Hoehn and Yahr, and the Schwab and England scores were determined. Logistic regression was used to examine associations of G2019S mutation status with motor phenotype and rate of motor decline. The LRRK2-associated PD patients had a mean age of onset of 56.25 ± 12.05 years and in most cases (58.6%) a postural instability gait difficulty (PIGD) phenotype. The mean annual decline in the MDS-UDRS III motor score and the Hoehn and Yahr staging was of 1.3% and 2%, respectively. The PIGD phenotype predicted a more rapid progression of motor impairment. The PD motor phenotype and motor scores were similar in the LRRK2-associated PD group and in the GU PD group, with no significant differences in the progression rate of motor impairment. Motor phenotype seems to be similar in LRRK2-related PD and idiopathic PD.

The associations between fatigue, apathy, and depression in Parkinson's disease.

Fatigue and apathy are two of the most common and most disabling non-motor symptoms of Parkinson's disease (PD). They have a high coincidence and can often be confused; moreover, their relationship is not fully understood. The aim of our study was to describe the coincidence of apathy with different fatigue domains in the presence/absence of depression and to separately describe the associations of different aspects of primary and secondary fatigue with apathy and other clinical and disease-related factors. A total of 151 non-demented patients with PD were examined using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Starkstein Apathy Scale, Multidimensional Fatigue Inventory (MFI), Beck Depression Inventory-II, and Epworth Sleepiness Scale. The prevalence and severity of fatigue and apathy were significantly higher in depressed PD patients. However, our results show that depression, fatigue, and apathy can be clearly distinguished in PD. Apathy was associated with the MFI's-reduced motivation domain in both depressed and non-depressed patients. However, apathy was associated with mental fatigue aspects only in non-depressed patients, and it was not related to the physical aspects of fatigue in any of the studied groups. Although the pathophysiology of fatigue and apathy in PD is clearly multifactorial, in a proportion of PD patients, these symptoms are associated with depression, dopaminergic depletion in the mesocorticolimbic structures, and disruption of the prefrontal cortex-basal ganglia axis. Therefore, in some PD patients, adequate management of depression and optimal dopaminergic medication may improve both fatigue and apathy.

Relationships among cognitive impairment, sleep, and fatigue in Parkinson's disease using the MDS-UPDRS.

Non-motor complications of Parkinson's disease (PD), specifically cognitive impairment, sleep disturbances, and fatigue, are recognized as important contributors to poor patient outcomes and quality of life. How sleep problems and fatigue interrelate and impact cognitive function, however, has not systematically been investigated across the stages of PD. The aim of our study was to investigate the relationships among cognitive impairment, night-time sleep problems, daytime sleepiness, and fatigue across all severities of PD. We examined these non-motor problems using the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) in a study of 1319 PD patients drawn from three large cohort studies: the Parkinson's Progressive Markers Initiative, the Rush University PD Cognitive-Behavioral-Imaging study, and the Movement Disorder Society-Unified Parkinson's Disease Rating Scale Clinimetric testing program study, which spanned the gamut of disease, from early to advanced PD. Generalized linear mixed models with logit linking functions and covariates including study cohort, age, PD duration, and presence/absence of PD medications were used to examine relationships between these three non-motor symptoms and cognitive impairment. Of these three frequent, and often inter-twined, non-motor complications, greater daytime sleepiness and fatigue were associated with worse cognitive impairment across the full spectrum of PD (F[16,1158]=2.40 and F[16,1158]=3.45 respectively, p's<0.0005), but an association with night-time sleep was not detected (p=0.83). Given this association of daytime sleepiness and fatigue with cognitive impairment, clinical monitoring for these problems should be considered across all points in the PD spectrum, from early to more advanced disease.

Official Japanese Version of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale: validation against the original English version.

The Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease (PD) Rating Scale (UPDRS) (MDS-UPDRS) has been developed and is now available in English. Part of the overall program includes the establishment of official non-English translations of the MDS-UPDRS. We present the process for completing the official Japanese translation of the MDS-UPDRS with clinimetric testing results. In this trial, the MDS-UPDRS was translated into Japanese, underwent cognitive pre-testing, and the translation was modified after taking the results into account. The final translation was approved as Official Working Draft of the MDS-UPDRS Japanese version and tested in 365 native-Japanese-speaking patients with PD. Confirmatory analyses were used to determine whether the factor structure for the English-language MDS-UPDRS could be confirmed in data collected using the Official Working Draft of the Japanese translation. As a secondary analysis, we used exploratory factor analyses to examine the underlying factor structure without the constraint of a pre-specified factor organization. Confirmatory factor analysis revealed that Comparative Fit Index for all Parts of the MDS-UPDRS exceeded the minimal standard of 0.90 relative to the English version and therefore Japanese translation met the pre-specified criterion to be designated called an OFFICIAL MDS TRANSLATION. Secondary analyses revealed some differences between the English-language MDS-UPDRS and the Japanese translation, however, these differences were considered to be within an acceptable range. The Japanese version of the MDS-UPDRS met the criterion as an Official MDS Translation and is now available for use (www.movementdisorders.org).

Movement Disorder Society Unified Parkinson Disease Rating Scale experiences in daily living: Longitudinal changes and correlation with other assessments

The Movement Disorder Society (MDS) commissioned a revision of the UPDRS with the goals of improving instructions and definitions, more accurately evaluating milder features, and assessing patient-reported outcomes and nonmotor features. To date, no study has evaluated longitudinal changes in components of the MDS-UPDRS over time or correlated these with changes in other scales of various symptoms. We assessed Parts I and II of the MDS-UPDRS (non-Motor and Motor Experiences of Daily Living [nM-EDL, M-EDL]) as well as a number of other scales of motor, cognitive and behavioral function in a large population of patients (n = 383) with early- to mid-stage Parkinson's disease (PD) who had previously participated in a trial of a putative disease-modifying agent. Both parts of a MDS-UPDRS showed significant change over the 3-year follow-up period, with M-EDL scores declining to a greater extent than nM-EDL. Both the scores and their changes over time correlated relatively well with other rating scales of similar disease aspects. Modest correlations with the original version of the UPDRS supported the increased attention to nonmotor symptoms as well as milder levels of severity in the MDS-UPDRS. The M-EDL was much more sensitive to change over time in these early- to mid-stage patients than the original UPDRS Activities of Daily Living (ADL) scale. Finally, we showed no change over time in a small group of individuals with dopamine transporter single-photon emission computed tomography scans without evidence for dopamine deficiency. The nM-EDL and M-EDL components of the MDS-UPDRS provide an effective, relevant measure of change in the broad spectrum of symptoms of PD over the first decade of the disease.

The MDS-UPDRS Part II (motor experiences of daily living) resulted useful for assessment of disability in Parkinson's disease

ObjectiveTo evaluate the motor experiences of daily living section of the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS M-EDL) for assessing disability in PD patients; to determine the association between disability and quality of life; and to identify cut-off score ranges for no, mild, moderate and severe disability with this measure. MethodsInternational, observational, cross-sectional study of 435 PD patients, assessed with: MDS-UPDRS, Hoehn and Yahr staging, Rapid Assessment of Disability Scale, Clinical Impression of Severity Index for PD, Parkinson's Disease Questionnaire-8 and EQ-5D. Descriptive statistics, Spearman's rank correlation coefficients, Kruskal–Wallis test for group comparisons, ordinal logistic regression analysis for setting cut-off values and a step-wise multiple linear regression model were calculated. ResultsMDS-UPDRS M-EDL correlated 0.70–0.80 with other disability measures, and −0.46 to 0.74 with quality of life scales. Scores significantly increased with higher disease duration and severity (p < 0.001). Cut-off values for the M-EDL were: 0–2 points, no disability; 3–16, mild; 17–31, moderate; and 32 points or more, severe. Linear regression analysis identified the MDS-UPDRS nM-EDL section as the main determinant of M-EDL, followed by the rest of MDS-UPDRS sections (explained variance: 59%). ConclusionsMDS-UPDRS M-EDL proved to be useful for assessing disability in PD.

Assessing the non‐motor symptoms of Parkinson's disease: MDS‐UPDRS and NMS Scale

Although Parkinson's disease (PD) is characterized by typical motor manifestations, non-motor symptoms (NMS) are an outstanding part of the disease. At present, several specific instruments for assessment of NMS are available. The objective of our study was to determine the performance of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Part I - Non-Motor Aspects of Experiences of Daily Living (nM-EDL) compared with the Non-Motor Symptoms Scale (NMSS). To this purpose, 434 consecutive patients with PD were included in an international, observational, cross-sectional study. The association between scores of both scales was determined by the Spearman rank correlation coefficient. Equations for transformation of total score of a scale to the other were constructed from weighted regression models and both, transformed and observed score, contrasted by means of the Lin's Concordance Correlation Coefficient (LCCC) and Bland-Altman plot. As a whole, the prevalence of the NMS according to each scale was quite similar, and most of the correlations between their corresponding components were high (r(S) > 0.60). The total score correlation of the MDS-UPDRS Part I with the NMSS was high (r(S) = 0.81). Concerning the transformed scores, estimated scores only partially approach the observed ones (sharing about 60-64% of the variance) because residual variance increased with increasing magnitudes of the scores, i.e. the most severe patients (Bland-Altman plot; LCCC < 0.60 for severe patients). (i) MDS-UPDRS Part I (nM-EDL) and NMSS showed a strong convergent validity; (ii) however, transformed scores using the equations from weighted regression models showed that for patients with the most severe NMS they are not concordant.

Instruments for holistic assessment of Parkinson’s disease

Assessment of Parkinson's disease is a complex matter as a consequence of the variety of manifestations and complications that can be present in a patient. Although a really holistic assessment is probably a utopia, a comprehensive evaluation is possible using a combination of measures completed by health professionals, patients and/or caregivers. In PD, main domains requiring assessment include motor impairment, motor complications, non-motor symptoms, disability, and patient-reported outcomes. Such scales like the Movement Disorder Society-Unified Parkinson's Disease Rating Scale and the battery of Scales for Outcomes in Parkinson's disease (SCOPA) provide a wide information on the most relevant aspects of the disease. Hoehn and Yahr staging, global impression, and quality of life measures furnish summarized whole evaluations and comprehensive non-motor symptom assessments help to identify and evaluate this kind of manifestations. This article shows a pragmatic review of common instruments (rating scales and questionnaires) usable for a comprehensive assessment of PD and provides information about sources for guiding the selection of measures and outcome analyses.

Improved Clinical Status, Quality of Life, and Walking Capacity in Parkinson's Disease After Body Weight-Supported High-Intensity Locomotor Training

ObjectiveTo evaluate the effect of body weight-supported progressive high-intensity locomotor training in Parkinson's disease (PD) on (1) clinical status; (2) quality of life; and (3) gait capacity. DesignOpen-label, fixed sequence crossover study. SettingUniversity motor control laboratory. ParticipantsPatients (N=13) with idiopathic PD (Hoehn and Yahr stage 2 or 3) and stable medication use. InterventionsPatients completed an 8-week (3 × 1h/wk) training program on a lower-body positive-pressure treadmill. Body weight support was used to facilitate increased intensity and motor challenges during treadmill training. The training program contained combinations of (1) running and walking intervals, (2) the use of sudden changes (eg, in body weight support and speed), (3) different types of locomotion (eg, chassé, skipping, and jumps), and (4) sprints at 50 percent body weight. Main Outcome MeasuresThe Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Parkinson's Disease Questionnaire-39 items (PDQ-39), and the six-minute walk test were conducted 8 weeks before and pre- and posttraining. ResultsAt the end of training, statistically significant improvements were found in all outcome measures compared with the control period. Total MDS-UPDRS score changed from (mean ± 1SD) 58±18 to 47±18, MDS-UPDRS motor part score changed from 35±10 to 29±12, PDQ-39 summary index score changed from 22±13 to 13±12, and the six-minute walking distance changed from 576±93 to 637±90m. ConclusionsBody weight-supported progressive high-intensity locomotor training is feasible and well tolerated by patients with PD. The training improved clinical status, quality of life, and gait capacity significantly.

Medication and subthalamic nucleus deep brain stimulation similarly improve balance and complex gait in Parkinson disease

BackgroundDopaminergic medications and subthalamic nucleus deep brain stimulation (STN-DBS) alleviate motor symptoms in Parkinson disease, but balance and gait are more variably affected. Balance reports are particularly inconsistent. Further, despite their prevalence in daily life, complex gait situations including backward and dual task gait are rarely studied. We aimed to assess how medications, STN-DBS, and both therapies combined affect balance and complex gait. MethodsTwelve people with Parkinson disease were evaluated OFF medication with STN-DBS OFF and ON as well as ON medication with STN-DBS OFF and ON. Motor impairment was measured with the Movement Disorder Society Unified Parkinson Disease Rating Scale motor section (MDS-UPDRS-III). The Mini-Balance Evaluations Systems Test, timed-up-and-go, and dual task timed-up-and-go measured balance and mobility. Preferred-pace forward, fast as possible forward, backward, dual task forward, and dual task backward gait were also analyzed. ResultsMedication improved MDS-UPDRS-III scores, dual task timed-up-and-go, and stride length across all gait tasks. STN-DBS improved MDS-UPDRS-III scores, balance scores, dual task timed-up-and-go, and stride length and velocity across all gait tasks. Medication and STN-DBS combined did not provide additional benefits over either therapy alone. ConclusionsOverall, dopaminergic medications and STN-DBS provided similar improvements in balance and gait tasks, although the effects of STN-DBS were stronger, potentially due to reductions in medication doses after surgery. Lack of synergistic effect of treatments may suggest both therapies improve balance and gait by influencing similar neural pathways.

Expanded and independent validation of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS).

The Movement Disorder Society-UPDRS (MDS-UPDRS) was published in 2008, showing satisfactory clinimetric results and has been proposed as the official benchmark scale for Parkinson's disease. The present study, based on the official MDS-UPDRS Spanish version, performed the first independent testing of the scale and adds information on its clinimetric properties. The cross-culturally adapted MDS-UPDRS Spanish version showed a comparative fit index ≥ 0.90 for each part (I-IV) relative to the English-language version and was accepted as the Official MDS-UPDRS Spanish version. Data from this scale, applied with other assessments to Spanish-speaking Parkinson's disease patients in five countries, were analyzed for an independent and complementary clinimetric evaluation. In total, 435 patients were included. Missing data were negligible and moderate floor effect (30 %) was found for Part IV. Cronbach's α index ranged between 0.79 and 0.93 and only five items did not reach the 0.30 threshold value of item-total correlation. Test-retest reliability was adequate with only two sub-scores of the item 3.17, Rest tremor amplitude, reaching κ values lower than 0.60. The intraclass correlation coefficient was higher than 0.85 for the total score of each part. Correlation of the MDS-UPDRS parts with other measures for related constructs was high (≥ 0.60) and the standard error of measurement lower than one-third baseline standard deviation for all subscales. Results confirm those of the original study and add information on scale reliability, construct validity, and precision. The MDS-UPDRS Spanish version shows satisfactory clinimetric characteristics.

Randomized Controlled Trial of Community-Based Dancing to Modify Disease Progression in Parkinson Disease

Background. Tango dancing has been effective in improving measures of physical function in people with Parkinson disease (PD). However, all previous studies were institution-based, tested participants on medication, and employed short-term interventions. Objective. To determine the effects of a 12-month community-based tango program for individuals with PD on disease severity and physical function. Methods. Sixty-two participants were randomly assigned to a twice weekly, community-based Argentine Tango program or a Control group (no intervention). Participants were assessed off anti-Parkinson medication at baseline, 3, 6, and 12 months. The primary outcome measure was the Movement Disorders Society–Unified Parkinson Disease Rating Scale 3 (MDS-UPDRS-3). Secondary outcome measures were the MDS-UPDRS-1, MDS-UPDRS-2, MiniBESTest balance test; Freezing of Gait Questionnaire (FOG_Q); 6-Minute Walk Test (6MWT); gait velocity for comfortable forward, fast as possible forward, dual task, and backward walking; and Nine-Hole Peg Test (9HPT). Results. Groups were not different at baseline. Overall, the Tango group improved whereas the Control group showed little change on most measures. For the MDS-UPDRS-3, there was no significant change in the Control group from baseline to 12 months, whereas the Tango group had a reduction of 28.7% (12.8 points). There were significant group by time interactions for MDS-UPDRS-3, MiniBESTest, FOG_Q, 6MWT, forward and dual task walking velocities, and 9HPT in favor of the dance group. Conclusions. Improvements in the Tango group were apparent off medication, suggesting that long-term participation in tango may modify progression of disability in PD.

Five Times Sit-to-Stand Test Performance in Parkinson's Disease

Duncan RP, Leddy AL, Earhart GM. Five times sit-to-stand test performance in Parkinson's disease. Objectives To (1) determine intrarater and test-retest reliability of the Five times sit-to-stand test (FTSTS) in Parkinson's disease (PD), (2) characterize FTSTS performance in PD at different disease stages, (3) determine predictors of FTSTS performance in PD, and (4) determine the utility of the FTSTS for discriminating between fallers and nonfallers with PD, identifying an appropriate cutoff score to delineate between these groups. Design Measurement study of community-dwelling individuals with idiopathic PD. Setting A medical school laboratory. Participants Participants (N=82) were recruited via population-based sampling. The final sample included 80 participants. Two were excluded because of exclusion criteria and an unrelated illness, respectively. Interventions Not applicable. Main Outcome Measures FTSTS time (seconds) was the primary outcome measure. Secondary outcome measures included the Mini-Balance Evaluation Systems Test (Mini-BEST), Maximal Voluntary Isometric Contraction–Quadriceps, 9-Hole Peg Test (9HPT), 6-minute walk, Freezing of Gait Questionnaire, Activities-Specific Balance Confidence Scale, Physical Activity Scale for the Elderly, Parkinson's Disease Questionnaire-39, and Movement Disorders Society–Unified Parkinson's Disease Rating Scale. Results Interrater and test-retest reliability for the FTSTS were high (intraclass correlation coefficients: .99 and .76, respectively). Mean FTSTS performance was 20.25±14.12 seconds. All mobility measures were significantly correlated with FTSTS ( P<.01). The Mini-BEST and 9HPT together explained 53% of the variance in FTSTS. Receiver operating characteristic analysis determined a cutoff of 16.0 seconds (sensitivity, .75; specificity, .68) for discriminating between fallers and nonfallers, with an area under the curve of .77. Conclusions The FTSTS is a quick, easily administered measure that is useful for gross determination of fall risk in individuals with PD.