Unified Parkinson's Disease Rating Scale Motor Research Articles

The AMC Linear Disability Score in patients with newly diagnosed Parkinson disease

The aim of this study was to examine the clinimetric properties of the AMC Linear Disability Score (ALDS), a new generic disability measure based on Item Response Theory, in patients with newly diagnosed Parkinson disease (PD). A sample of 132 patients with PD was evaluated using the Hoehn and Yahr (H&Y), the Unified PD Rating Scale motor examination, the Schwab and England scale (S&E), the Short Form-36, the PD Quality of Life Questionnaire, and the ALDS. The internal consistency reliability of the ALDS was good (alpha = 0.95) with 55 items extending the sufficient item-total correlation criterion (r > 0.20). The ALDS was correlated with other disability measures (r = 0.50 to 0.63) and decreasingly associated with measures reflecting impairments (r = 0.36 to 0.37) and mental health (r = 0.23 to -0.01). With regard to know-group validity, the ALDS indicated that patients with more severe PD (H&Y stage 3) were more disabled than patients with mild (H&Y stage 1) or moderate PD (H&Y stage 2) (p < 0.0001). The ALDS discriminated between more or less severe extrapyramidal symptoms (p = 0.001) and patients with postural instability showed lower ALDS scores compared to patients without postural instability (p = or< 0.0001). Compared to the S&E (score 100% = 19%), the ALDS showed less of a ceiling effect (5%). The AMC Linear Disability Score is a flexible, feasible, and clinimetrically promising instrument to assess the level of disability in patients with newly diagnosed Parkinson disease.

Changes in Glucose Metabolism in Cerebral Cortex and Cerebellum Correlate With Tremor and Rigidity Control by Subthalamic Nucleus Stimulation in Parkinson’s Disease: A Positron Emission Tomography Study

Objective. Employing [(18) F]fluorodeoxyglucose (FDG) positron emission tomography (PET) to assess the correlation between the effect of deep brain stimulation (DBS) on the subthalamic nucleus (STN) and the regional cerebral metabolic rate of glucose (rCMRGlc) in advanced Parkinson's disease patients (N=8). Materials and Methods. On the basis of patients' diary records, we performed FDG-PET during the off-period of motor activity with on- or off-stimulation by STN-DBS on separate days and analyzed the correlation between changes in motor symptoms and alterations in the rCMRGlc. Result. When FDG-PET was performed, the motor score on the unified Parkinson's disease rating scale (UPDRS) was 64% lower with on-stimulation than with off-stimulation (p<0.001, Wilcoxon single-rank test). STN-DBS increased the rCMRGlc in the posterior part of the right middle frontal gyrus, which corresponded to the premotor area, and the right anterior lobe of the cerebellum (p<0.005, paired t-test). No region exhibited a decrease in rCMRGlc. Among the items of the UPDRS motor score, the changes in resting tremor and rigidity of the left extremities showed a significant correlation with the changes in rCMRGlc observed in the right premotor area (p<0.02 and p<0.05, respectively, Spearman's rank correlation). Conclusions. STN-DBS either activates the premotor area or normalizes the deactivation of the premotor area. These FDG-PET findings obtained are consistent with the idea that STN-DBS modifies the activities of neural circuits involved in motor control.

Quetiapine for agitation or psychosis in patients with dementia and parkinsonism

To assess the efficacy and tolerability of quetiapine for agitation or psychosis in patients with dementia and parkinsonism. Multicenter randomized, double-blind, placebo-controlled parallel groups clinical trial involving 40 patients with dementia with Lewy bodies (n = 23), Parkinson disease (PD) with dementia (n = 9), or Alzheimer disease with parkinsonian features (n = 8). The main outcome measure for efficacy was change in the Brief Psychiatric Rating Scale (BPRS) from baseline to 10 weeks of therapy. For tolerability it was change in the Unified PD Rating Scale (UPDRS) motor section over the same time period. The trial was confounded by the need for a design change and incomplete recruitment. No significant differences in the primary or secondary outcome measures of efficacy were observed. An unexpectedly large placebo effect, inadequate dosage (mean 120 mg/day), and inadequate power may have contributed to lack of demonstrable benefit. Quetiapine was generally well-tolerated and did not worsen parkinsonism, but was associated with a trend toward a decline on a measure of daily functioning. Quetiapine was well-tolerated and did not worsen parkinsonism. Although conclusions about efficacy may be limited, the drug in the dosages used did not show demonstrable benefit for treating agitation or psychosis in patients with dementia and parkinsonism. These findings are in keeping with prior studies reporting limited efficacy of various medications for reducing behavioral problems in demented patients.

Ropinirole 24-hour prolonged release

To evaluate the efficacy of ropinirole 24-hour prolonged release (ropinirole 24-hour) as an adjunct to levodopa in patients with Parkinson disease (PD) and motor fluctuations. In a double-blind, placebo-controlled, 24-week study, 393 subjects with PD were randomized to ropinirole 24-hour (n = 202) or placebo (n = 191). The primary outcome measure was reduction in hours of daily "off" time. At week 24, the mean dose of ropinirole 24-hour was 18.8 mg/day with a mean reduction in daily levodopa of 278 mg. There was a mean reduction in daily "off" time of 2.1 hours in the ropinirole 24-hour group and 0.3 hours with placebo. Secondary outcome measures including change in hours and percent of daily "on" time and "on" time without troublesome dyskinesia, Unified PD Rating Scale motor and activities of daily living subscales, Beck Depression Inventory-II, PDQ-39 subscales of mobility, activities of daily living, emotional well-being, stigma and communication, and PD Sleep Scale were significantly improved at week 24 with ropinirole 24-hour. The most common adverse events (AE) with ropinirole 24-hour were dyskinesia, nausea, dizziness, somnolence, hallucinations, and orthostatic hypotension and AEs led to study withdrawal in 5% of both the active and placebo groups. Ropinirole 24-hour was effective and well tolerated as adjunct therapy in patients with Parkinson disease (PD) not optimally controlled with levodopa. Ropinirole 24-hour demonstrated an improvement in both motor and non-motor PD symptoms, while permitting a reduction in adjunctive levodopa dose.

Abnormal temporal discrimination threshold in patients with multiple system atrophy

The temporal discrimination threshold (TDT), the shortest time interval that allows two temporally separated successive stimuli to be perceived as two different stimuli, is a constituent of kinesthetic sensation. Intact kinesthesia is a necessity for well-controlled voluntary movements. In patients with Parkinson's disease and dystonia, abnormally increased TDT has been reported and it may contribute to the pathophysiology of motor deficits. We explored the integrity and clinical significance of TDT in patients with multiple system atrophy (MSA). A total of 30 de novo patients with MSA and 11 age-matched normal controls were included. The TDT values were measured in the feet with four different paradigms (ascending and descending interstimuli intervals; same and different point stimulation). The Unified Parkinson's Disease Rating Scale (UPDRS) Motor and the International Cooperative Ataxia Rating Scale (ICARS) scores were measured for parkinsonian and cerebellar deficits, respectively. Means of the TDT values of the patients with MSA were higher than those of the controls. The TDT values correlated with UPDRS Motor scores independent of ICARS scores. Among the parkinsonian motor deficits, only the UPDRS Motor subscores representing bradykinesia correlated with the TDT values. In patients with MSA, abnormal somatic sensory processing seems to be associated with damage to the nigrostriatal dopaminergic and/or striatal neurons.

Magnetic resonance spectroscopic evidence for presupplementary motor area neuronal dysfunction in Parkinson's disease

The anterior cingulate (AC) gyrus and the presupplementary motor area (pre-SMA) show pathological changes in Parkinson's disease (PD). We examined if PD patients show magnetic resonance spectroscopy (MRS) changes in NAA/Cr in the AC, pre-SMA, or posterior cingulate (PC). Forty-four (27 male, 17 female) healthy nondemented PD patients and 38 controls (18 male, 20 female) 65 years of age and older were examined using the Unified Parkinson's Disease Rating Scale (UPDRS), Mini-Mental State Examination, Frontal Assessment Battery, and Geriatric Depression Scale. MRS was performed at 1.5 T. Voxels (8 cc; PRESS; TE = 80; TR = 1,600 ms) were placed mid-sagittally. Gray matter and white matter volumes were measured within voxels using SPM2. Spectra were analyzed using LC model to yield NAA/Cr and Cho/Cr. Demographic and cognitive measures did not differ between groups. Motor UPDRS was 17.7 +/- 8.8 for PD. Pre-SMA NAA/Cr was lower in PD (PD: 1.39 +/- 0.17; control: 1.47 +/- 0.16; P = 0.045) and correlated negatively with age (r = 0.39; P = 0.01), but not with UPDRS, disease duration, or dopamine equivalents. AC and PC NAA/Cr and Cho/Cr in any region did not differ (P > 0.05). In conclusion, pre-SMA NAA/Cr was selectively decreased in PD, consistent with neuronal dysfunction. This should be further examined as a biomarker of disease in PD.

End-of-dose deterioration in non ergolinic dopamine agonist monotherapy of Parkinson’s disease

The study was designed to investigate the possible occurrence of "wearing-off" (WO) during dopamine agonist (DA) monotherapy. Sixty patients with "de novo" idiopathic PD were randomised into one of two DA monotherapy branches to receive oral ropinirole at 15 mg per day, or pramipexole at 2.1 mg per day. DA doses could be increased in the following two years but levodopa could not be added until the study ended. WO was assessed by self-evaluation charts confirmed by a blinded observation of a 30% or greater deterioration in the Unified Parkinson's Disease Rating Scale (UPDRS) motor score. Proc Mixed and Kaplan-Meier curves evaluated treatment variables as a function of time. T-tests were used to compare post-hoc variables reclassified according to WO occurrence. Thirty patients received ropinirole, and 30 pramipexole monotherapy. Eighteen patients (30%) experienced "wearing-off" 15-21 months after beginning monotherapy. No differences were observed between treatments. WO phenomena was observed 3.4+/-0.3 hours after intake of the morning or afternoon dose and consisted of UPDRS score worsening by 11.1+/-2.1 points (69-111% more than "on" score). Statistical evaluation gave evidence of differences between patients who experienced WO and those who did not: UPDRS motor scores obtained at admission to the study were higher (by 3.4+/-0.2 points, p=0.01 t-test) and DA doses at 6-12 months were higher in fluctuating patients. UPDRS motor scores deteriorated, however. similarly and there were no differences, in UPDRS scores recorded in ON conditions, between fluctuating and non-fluctuating patients at the end of the study. Our findings provide evidence of WO phenomena in patients with early PD receiving non-ergolinic DA monotherapy.

Continued efficacy and safety of subcutaneous apomorphine in patients with advanced Parkinson's disease

The study purpose was to assess the efficacy of intermittent subcutaneous apomorphine (APO) as acute therapy for off episodes in advanced Parkinson's disease (PD) patients who had previously received APO for ⩾3 months. Patients ( n = 62 ) were randomized to receive double-blind treatment with APO at their typically effective dose (TED; APO), APO at their TED+0.2 mL (2.0 mg; APO+2), placebo at volume equal to their TED (PL), or placebo at volume equal to their TED+0.2 mL (PL+2), for a single off episode. Significantly greater improvement in mean Unified PD rating scale motor scores was seen with pooled APO versus pooled placebo 20 min after administration (−24.2 vs. −7.4; p < 0.0001 ); the difference was also significant at 10 min ( p < 0.0001 ). Overall adverse event incidence did not significantly differ between pooled APO and pooled PL. This study supports the long-term use of intermittent APO as effective acute therapy for off episodes in advanced PD patients.

Metric attributes of the unified Parkinson's disease rating scale 3.0 battery: Part II, construct and content validity

This article is the second of a two-part series concerning the metric properties of the following three Parkinson's disease (PD) scales: modified Hoehn and Yahr staging (H&Y), Schwab and England (S&E), and Unified Parkinson's Disease Rating Scale (UPDRS) 3.0. Part II focuses on construct and content validity. To assess construct validity, a sample of 1,136 PD patients completed the above-mentioned PD scales. Correlation coefficients between measures of disability and dysfunction [S&E, UPDRS Activities of Daily Living (ADL), and UPDRS Motor Examination] were |r| = 0.69-0.77, indicating good convergent validity. Results showed that the S&E (F(5,945) = 193.47; P < 0.0001) and UPDRS subscales discriminated between modified H&Y stages (F(20,2784) = 25.28; P < 0.001). A panel of 12 to 13 international experts rated the relevance of the scales and items. This enabled the scales' content validity index to be calculated, which ranged from 41.7% (UPDRS Mentation) to 83.3% (UPDRS Motor Examination). In conclusion, while the modified H&Y, S&E, and UPDRS displayed satisfactory construct validity, the content validity of all scales except UPDRS Motor Examination failed to attain adequate standards.

New semiquantitative assessment of123I-FP-CIT by an anatomical standardization method

We evaluated a new semiquantitative procedure to more easily and objectively estimate the striatal uptake of 123I-FP-CIT in patients with Parkinsonian syndrome (PS) and essential tremor (ET), using an anatomical standardization method, the Neurostat. Eleven patients with PS and 8 with ET were examined by clinical assessment and 123I-FP-CIT SPECT imaging. The modified Hoehn and Yahr Staging Scale and Unified Parkinson's Disease Rating Scale (UPDRS) were used to assess the stage and severity of the disease. The co-registered MR and SPECT images were created with fusion software included in Neurostat. On the cross section, which shows the largest area of striate, irregular shaped regions of interest corresponding to the striate and occipital cortex were drawn. Then the ratio of specific striatal uptake to non-specific occipital cortex, V3"(F), was calculated. Another calculation was done by VOIClassic, which is a software included in Neurostat to estimate the counts per voxel of anatomically defined regions such as caudate nucleus, putamen, occipital cortex, and total cortex. Using these count data, the ratio of specific striatal uptake to non-specific occipital cortex, V3"(OC), and total cortex, V3"(TC), was calculated. A fair linear correlation was observed between V3"(OC) and V3"(F) (y = 1.53x + 1.40; r = 0.756; p < 0.01), as well as between V3"(TC) and V3"(F) (y = 1.24x + 1.43; r = 0.713; p < 0.01). Both V3"(OC) and V3"(TC) yielded similar tendencies. Concerning discrimination between ET and PS, there was a significant difference between the mean V3" of PS and ET (p < 0.01). Concerning the correlation between V3" value and the severity of PS, the UPDRS motor score significantly correlated with the V3"(F) value (rs = -0.816). However, V3"(OC) and V3"(TC) correlated less with UPDRS (rs = -0.667 and -0.645, respectively). Semiquantitative parameters, V3"(OC) and V3"(TC), calculated by VOIClassic including the Neurostat system are useful and easily calculable parameters as well as V3"(F) for the differential diagnosis of PS from ET.

The effects of random whole-body-vibration on motor symptoms in Parkinson's disease

It is well known that applying vibrations to men influences multiple physiological functions. The authors analysed post effects of whole-body-vibration (WBV) on motor symptoms in Parkinson's disease (PD). Sixty-eight persons with PD were randomly subdivided into one experimental and one control group. Motor symptoms were assessed by the UPDRS (Unified Parkinson's Disease Rating Scale) motor score. A cross-over design was used to control treatment effects. The treatment consisted of 5 series of whole-body-vibration taking 60 seconds each. On average a highly significant (p<0.01) improvement of 16.8% in the UPDRS motor score was found in the treatment group. Only marginal changes (p>0.05) were found in the control group. The cross-over procedure showed comparable treatment effects (14.7% improvement after treatment). With respect to different symptom clusters only small changes were found in limb akinesia and cranial symptoms. By contrast, tremor and rigidity scores were improved by 25% and 24%, respectively. According to the structure of symptom changes it is unlikely that these effects are explainable on peripheral sensory level, exclusively. With respect to the findings of other studies one can speculate about changes in activation of the supplementary motor area and in neurotransmitter functions.

Open-Label Trial Regarding the Use of Acupuncture and Yin Tui Na in Parkinson's Disease Outpatients: A Pilot Study on Efficacy, Tolerability, and Quality of Life

This study evaluates the effects of sequential tui na massage, acupuncture, and instrument-delivered qigong for patients with Parkinson disease (PD) over a 6-month period. Patients received weekly treatments, which included tui na massage prior to acupuncture followed by instrument-delivered qigong. Each patient was assessed at baseline and at 6 months. The setting was an outpatient research/academic clinic for patients with PD and nonacademic acupuncture clinic. Twenty-five (25) patients with idiopathic PD were the subjects. Before and after treatment patients were evaluated with the Unified Parkinson Disease Rating Scale (UPDRS), Hoehn and Yahr Staging (H&Y), Schwab and England Activities of Daily Living (S & E), Beck Depression Inventory (BDI), Parkinson's Disease Questionnaire (PDQ-39) quality of life assessment, and patient global assessments. There were no significant improvements in treatment measures; however, there was a 2.4-point worsening in UPDRS motor scores (24.0 versus 26.4, p = 0.018). There was a 16% improvement in the PDQ- 39 total score (23.2 versus 19.6, p = 0.044) and a 29% improvement in the BDI (9.6 versus 6.8, p = 0.006). Sixteen (16) patients reported moderate to marked improvement. There were no adverse effects. Acupuncture is safe and well tolerated in patients with PD. Most patients reported subjective improvement. The BDI and PDQ-39 total score, measuring depression and quality of life, demonstrated some improvement, but UPDRS motor scores worsened.

Multiple balance tests improve the assessment of postural stability in subjects with Parkinson’s disease

Objectives: Clinicians often base the implementation of therapies on the presence of postural instability in subjects with Parkinson’s disease (PD). These decisions are frequently based on the pull test from...

Minimal clinically important change on the unified Parkinson's disease rating scale

The Unified Parkinson's Disease Rating Scale (UPDRS) is the main outcome measure in clinical trials of Parkinson's disease (PD). The minimal change that represents a clinically meaningful improvement is unknown. The objective of this study was to determine the minimal change on the UPDRS that represents a clinically meaningful improvement in early PD after 6 months of treatment. Data from two independent randomized treatment trials over 6 months involving 603 patients with de novo PD were analyzed to determine the minimal clinically important change (MCIC), referred to the status before treatment, for the UPDRS motor, activities of daily living (ADL), and total scores. An anchor-based method using ratings on a seven-point global clinical improvement was used. A change of five points on the UPDRS motor part was found to be the most appropriate cutoff score for all Hoehn and Yahr stages I to III, and a change of eight points for the UDPRS total score. For the UDPRS ADL score, an MCIC of two points for Hoehn and Yahr stages I/I.5 and II and of three points for Hoehn and Yahr stage II.5/III was the most appropriate cutoff score. These data give the first estimate for cutoffs defining clinically important changes in UPDRS ADL and motor scores. Further studies using larger databases from more diverse study populations are encouraged to better define and solidify the MCIC for the UPDRS.

Evaluation of physical therapy in parkinsonian patients with freezing of gait: a pilot study

Objective: Freezing of gait is a frequently disabling symptom in Parkinson's disease, poorly responding to dopaminergic treatment. We investigated the short-term effectiveness of a rehabilitation protocol in parkinsonian patients with freezing of gait. Design: Prospective, uncontrolled pilot study with open label design. Setting: Outpatient service for rehabilitation of neurological disorders. Subjects: Twelve patients (8 male, 4 female; aged 59-78 years; Hoehn-Yahr stage: 2-3; mean disease duration: 14.29±SD 4.1 years). Interventions: Patients attended three (45 min) sessions every week, over a six-week period, of physical therapy focused to improve balance, postural control and walking, and to learn new strategies for overcoming freezing of gait. Main outcome measures: Patients were evaluated before (T0), at the end (T1), and one month after (T2) rehabilitation by means of clinical rating scales (Unified Parkinson Disease Rating Scale-Motor Section; Freezing of Gait Questionnaire; Parkinson Disease Quality of Life Score) and gait parameters (number of strides, stride length and velocity) during a standardized walking test. Results: The scores of Freezing of Gait Questionnaire and of Parkinson Disease Quality of Life Questionnaire (but not of the Unified Parkinson Disease Rating Scale-Motor Section) were significantly improved after treatment (T1). Gait parameters were significantly improved at T1 and T2. Conclusions: We showed the potential short-term efficacy of a rehabilitative approach to freezing of gait in Parkinson's disease. The positive outcome was documented by clinical rating scales and objective gait evaluation. The rapid reversibility of the clinical benefit suggests that further studies are needed to better define the optimal frequency and duration of treatment.

Efficacy of bilateral subthalamic nucleus (STN) stimulation in Parkinson’s disease

Deep brain stimulation (DBS) has, for the most part, replaced irreversible stereotactic coagulations in the surgical treatment of advanced Parkinson's disease. This study was undertaken to evaluate the benefits of bilateral STN stimulation related to its potential risks and side effects. Twenty-nine consecutive Parkinsonian patients treated with STN-DBS were prospectively followed-up. Effects on Parkinsonian symptoms were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS). The evaluation was performed preoperatively and included postoperative follow-up evaluations at one and twelve months. All evaluations were made during the patient's best on-medication phase and postoperative follow-ups were conducted under both stimulator-on and stimulator-off conditions by a blinded neurologist. A neuropsychologist also evaluated the patients at every visit. Two patients were excluded from the analysis because of severe surgical complications and three for an infection demanding the removal of the stimulator material. Other complications and side effects were clearly milder and temporary. At twelve months after surgery dyskinesia scores in the UPDRS were 53% lower than preoperative values. The results of the UPDRS motor scores improved 31.4% and activities of daily living (ADL) scores increased 19% compared with the preoperative situation. Also, the daily levodopa dose was 22% lower. Neuropsychological changes were minor, except for some deterioration in verbal fluency. The majority of Parkinsonian patients experienced significant and long lasting relief from their motor symptoms and an improvement in ADL functions due to DBS-STN therapy when evaluated at the best on-medication phase.

Unified Parkinson's disease rating scale motor examination: Are ratings of nurses, residents in neurology, and movement disorders specialists interchangeable?

The Unified Parkinson's Disease Rating Scale (UPDRS) is widely used for the clinical evaluation of Parkinson's disease (PD). We assessed the rater variability of the UPDRS Motor examination (UPDRS-ME) of nurse practitioners, residents in neurology, and a movement disorders specialist (MDS) compared to a senior MDS. We assessed the videotaped UPDRS-ME of 50 PD patients. Inter-rater and intra-rater variability were estimated using weighted kappa (kappa(w)) and intraclass correlation coefficients (ICC). Additionally, inter-rater agreement was quantified by calculation of the mean difference between 2 raters and its 95% limits of agreement. Intra-rater agreement was also estimated by calculation of a 95% repeatability limits. The kappa(w) and ICC statistics indicated good to very good inter-rater and intra-rater reliability for the majority of individual UPDRS items and the sum score of the UPDRS-ME in all raters. However, for inter-rater agreement, it appeared that both nurses, residents, and the MDS consistently assigned higher scores than the senior MDS. Mean differences ranged between 1.7 and 5.4 (all differences P < 0.05), with rather wide 95% limits of agreement. The intra-rater 95% repeatability limits were rather wide. We found considerable rater difference for the whole range of UPDRS-ME scores between a senior MDS and nurse practitioners, residents in neurology, and the MDS. This finding suggests that the amount by which raters may disagree should be quantified before starting longitudinal studies of disease progression or clinical trials. Finally, evaluation of rater agreement should always include the assessment of the extent of bias between different raters.

Long-term benefits in quality of life provided by bilateral subthalamic stimulation in patients with Parkinson disease

The goals of this study were to evaluate long-term benefits in quality of life in patients with Parkinson disease (PD) after bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) and to evaluate the relationship between improvements in motor function and quality of life. Seventy-one patients who received bilateral STN stimulation implants and participated in follow-up review for at least 12 months were included in the study. Fifty-nine patients participated in a 12-month follow-up review and 43 patients in a follow-up review lasting at least 24 months. Patients' symptoms were assessed preoperatively by using the Unified PD Rating Scale (UPDRS) in the "medication-on" and "medication-off' conditions and quality of life was examined using the 39-item PD Questionnaire (PDQ-39). Patient evaluations were repeated postoperatively during periods of stimulation. The UPDRS activities of daily living (ADL) and motor scores as well as the PDQ-39 total, mobility, ADL, emotional well-being, stigma, and bodily discomfort scores were significantly improved at 12 months compared with baseline scores; the UPDRS ADL and motor scores as well as the PDQ-39 total, mobility, ADL, stigma, and bodily discomfort scores were significantly improved at the longest follow-up examination compared with baseline scores. There was a strong correlation between UPDRS motor and ADL scores and the PDQ-39 total, mobility, and ADL scores. Further analyses indicated that improvements in tremor were only correlated with PDQ-39 ADL subscale scores and rigidity was not correlated with any aspect of quality of life. Nevertheless, bradykinesia was strongly correlated with improvements in the PDQ-39 total, mobility, and ADL scores. Improvements in quality of life following bilateral DBS of the STN are maintained in the long term. These improvements are strongly correlated with improvements in motor function, primarily with regard to bradykinesia.

Quantitative measurements of alternating finger tapping in Parkinson's disease correlate with UPDRS motor disability and reveal the improvement in fine motor control from medication and deep brain stimulation

The Unified Parkinson's Disease Rating Scale (UPDRS) is the primary outcome measure in most clinical trials of Parkinson's disease (PD) therapeutics. Each subscore of the motor section (UPDRS III) compresses a wide range of motor performance into a coarse-grained scale from 0 to 4; the assessment of performance can also be subjective. Quantitative digitography (QDG) is an objective, quantitative assessment of digital motor control using a computer-interfaced musical keyboard. In this study, we show that the kinematics of a repetitive alternating finger-tapping (RAFT) task using QDG correlate with the UPDRS motor score, particularly with the bradykinesia subscore, in 33 patients with PD. We show that dopaminergic medication and an average of 9.5 months of bilateral subthalamic nucleus deep brain stimulation (B-STN DBS) significantly improve UPDRS and QDG scores but may have different effects on certain kinematic parameters. This study substantiates the use of QDG to measure motor outcome in trials of PD therapeutics and shows that medication and B-STN DBS both improve fine motor control.

99m Tc]TRODAT-1 SPECT imaging correlates with odor identification in early Parkinson disease

In vivo imaging of the dopamine transporter with [99mTc]TRODAT-1 (TRODAT) and olfactory testing have both been proposed as potential biomarkers in Parkinson disease (PD). To evaluate the relationship between TRODAT SPECT imaging, odor identification skills, and motor function in patients with early PD. Twenty-four patients with a clinical diagnosis of early-stage PD (mean Hoehn & Yahr stage = 1.4) underwent TRODAT imaging, Unified PD Rating Scale (UPDRS) ratings of motor function, and administration of the University of Pennsylvania Smell Identification Test (UPSIT). Brain images were obtained using a standardized processing protocol and specific uptake ratios for striatal regions of interest were calculated. Partial correlations between the imaging indices, disease duration, UPSIT scores, and UPDRS motor scores were then calculated. UPSIT scores were correlated with TRODAT uptake in the striatum as a whole (r = 0.66, p = 0.001). The putamen showed the strongest correlation with the UPSIT (r = 0.74; p < 0.001). The correlation between dopamine transporter density in the caudate and UPSIT was moderate (r = 0.36, p = 0.11), but was not significant. Olfactory function is highly correlated with dopamine transporter imaging abnormalities in early Parkinson disease (PD). Further studies are warranted to determine whether changes over time in these two measures are also correlated in early PD.