Citation

van der Heeden JF, Marinus J, Martinez-Martin P, Rodríguez-Blázquez C, Geraedts VJ, van Hilten JJ. Neurology 2016; 86(24): 2243-2250.

Affiliation

From the Department of Neurology (J.F.v.d.H., J.M., V.J.G., J.J.v.H.), Leiden University Medical Center, the Netherlands; and National Centre for Epidemiology and CIBERNED (P.M.-M., C.R.-B.), Carlos III Institute of Health, Madrid, Spain.

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1212/WNL.0000000000002768

PMID

27178702

Abstract

OBJECTIVE: Differences in disease progression in Parkinson disease (PD) have variously been attributed to 2 motor subtypes: tremor-dominant (TD) and postural instability and gait difficulty (PIGD)-dominant (PG). We evaluated the role of these phenotypic variants in severity and progression of nondopaminergic manifestations of PD and motor complications.

METHODS: Linear mixed models were applied to data from the Profiling Parkinson's disease (PROPARK) cohort (n = 396) to evaluate the effect of motor subtype on severity and progression of cognitive impairment (Scales for Outcomes in Parkinson's disease [SCOPA]-Cognition [SCOPA-COG]), depression (Hospital Anxiety and Depression Scale [HADS]), autonomic dysfunction (SCOPA-Autonomic [SCOPA-AUT]), excessive daytime sleepiness, psychotic symptoms (SCOPA-Psychiatric Complications [SCOPA-PC]), and motor complications. In first analyses, subtype as determined by the commonly used ratio of tremor over PIGD score was entered as a factor, whereas in second analyses separate tremor and PIGD scores were used.

RESULTS were verified in an independent cohort (Estudio Longitudinal de Pacientes con Enfermedad de Parkinson [ELEP]; n = 365).

RESULTS: The first analyses showed that PG subtype patients had worse SCOPA-COG, HADS, SCOPA-AUT, SCOPA-PC, and motor complications scores, and exhibited faster progression on the SCOPA-COG. The second analyses showed that only higher PIGD scores were associated with worse scores for these variables; tremor score was not associated with severity or progression of any symptom. Analyses in the independent cohort yielded similar results.

CONCLUSIONS: In contrast to PIGD, which consistently was associated with greater severity of nondopaminergic symptoms, there was no evidence of a benign effect of tremor. Our findings do not support the use of the TD subtype as a prognostic trait in PD. The results showed that severity of PIGD is a useful indicator of severity and prognosis in PD by itself.

© 2016 American Academy of Neurology.

Language: en