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THE PREDICTIVE VALUE OF DIFFERENT MOTOR FEATURES IN PARKINSON'S
  1. Angus Macleod,
  2. Carl Counsell
  1. Division of Applied Health Sciences, University of Aberdeen

Abstract

Background Other than tremor dominance (TD) or the postural instability-gait disorder phenotype (PIGD), little is known about what baseline motor characteristics influence prognosis in Parkinson's disease (PD).

Methods We analysed data from the PINE study, a prospective, community-based incident cohort of PD in Aberdeen, Scotland, recruited between 2002–09, with long term follow-up. Baseline motor features derived from the UPDRS part 3 scale were assessed as independent predictors of four outcomes: death, dependence (Schwab & England <80), “death or dependence”, and progression to Hoehn & Yahr stage 3 (H&Y3) using Cox regression adjusting for age.

Results 198 patients were analysed (median 6.1 years follow-up). In univariable analyses, bradykinesia score, axial score, limb score, axial/limb ratio, dopa-responsive signs, and dopa-non-reponsive signs were significant predictors of all outcomes. In univariable analyses, asymmetry predicted dependency and death or dependency and TD/PIGD only predicted H&Y3. In multivariable analyses bradykinesia and axial/limb ratio were independent predictors of death and death or dependency and axial score and dopa non-responsive symptoms were predictors for dependency and H&Y3.

Discussion Different motor characteristics were independent predictors of different outcomes. However, a variable relating to severity of axial signs was a common theme across three of these outcomes. Thus, at diagnosis, axial motor features appear to be important predictors of prognosis, perhaps stronger than the TD/PIGD classification and deserve further study.

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