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Updated Parkinsonís Rating Scale May Be Helpful in Designing Future Clinical Trials

A new study, supported in part by the Parkinson's Disease Foundation (PDF), finds that the updated Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) is a valuable and sensitive way for doctors to evaluate the motor and nonmotor symptoms of people early in the course of Parkinson’s disease (PD). This is the first effort to use this updated scale to follow the impact of Parkinson’s on daily life. The study appears in the December issue of Movement Disorders.

Five years ago, the International Parkinson and Movement Disorder Society updated and refined the standard rating scale for PD, the UPDRS. The original scale was developed over 20 years ago by Stanley Fahn, M.D., PDF's Scientific Director. Doctors may use this test to assess people’s symptoms and track the progression of disease. For Parkinson's research, a better measurement of the pace and direction of PD’s development means quicker, more efficient and less expensive ways of testing new medications through clinical trials. One difference in the new version is that it separately assesses the effects of motor and nonmotor symptoms on a person’s ability to go about daily routines and take care of him or herself.

Researchers led by Anthony Lang, M.D., at Toronto Western Hospital, wanted to find whether the updated MDS-UPDRS was effective and reliable, and to compare it to other ways of assessing PD symptoms. They tested 383 people with early to mid-stage PD using the portions of the MDS-UPDRS that rate nonmotor and motor experiences of daily living, then repeated the tests once a year for three years. They also evaluated study participants using other scales, including the Hoehn and Yahr scale and tests measuring depression and cognitive ability. Finally, they carried out the same assessments with 24 individuals initially misdiagnosed with PD who later were found not to have dopamine deficiency on brain scans (the hallmark sign of PD).

Results

  • As expected, the new MDS-UPDRS captured disease progression over the three-year follow-up period.
  • In reviewing the MDS-UPDRS scores, researchers found a greater decline in scores for movement symptoms, and a greater impact on a person’s ability to carry out daily activities.
  • The results of the MDS-UPDRS correlated well with those of other tests.
  • The new version of the MDS-UPDRS more effectively detected changes in PD symptoms over time.
  • Individuals who did not have dopamine deficiency showed no change in the impact of motor and nonmotor symptoms on daily activities.

What Does It Mean?

One of the major challenges in designing a clinical trial for PD is to identify a simple, sensitive and reliable measurement that will accurately measure the difference in outcomes between the investigated drug and the placebo. This study provides evidence that the updated MDS-UPDRS is a valuable and sensitive way for doctors to evaluate the motor and nonmotor symptoms of people with PD. Since most of the sections of the test that deal with the impact of symptoms on daily activities are filled out by people with PD and their caregivers, the study authors note that this self-reporting represents a simple method of evaluating PD over time that could be used by both specialists and other healthcare workers. After analyzing disease progression over three years, the authors have also noted that motor, rather than nonmotor symptoms of PD, have the greatest impact on a person’s ability to carry out routine tasks in the first decade of the disease.

This study was supported in part by an Advancing Parkinson's Treatments grant from PDF to the Longitutional And Biomarkers Study in Parkinson's Disease (LABS-PD). The results underscore the need to fund innovative collaborative programs that facilitate the movement of treatments from "bench to bedside" — a need that is wholeheartedly endorsed by PDF.

Learn More

Do you have questions about the MDS-UPDRS or other methods used to assess Parkinson's? Contact PDF’s toll-free HelpLine at (800) 457-6676 or info@pdf.org or use our free resources below.

View the PD ExpertBriefing: Understanding the Progression of Parkinson’s

Read About the MDS-UPDRS

Source Date: Jan 06 2014