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Goetz CG. Will Artificial Intelligence Outperform the Clinical Neurologist in the Near Future? No. Mov Disord Clin Pract 2021; 8:529-531. [PMID: 33981786 DOI: 10.1002/mdc3.13200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/26/2020] [Indexed: 11/08/2022] Open
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Fuller RLM, Sánchez-Ferro Á, Goetz CG, Martinez-Martin P, Stebbins GT. In Support of Electronic Versions of Movement Disorder Society Rating Scales. Mov Disord 2021; 36:270-271. [PMID: 33492790 DOI: 10.1002/mds.28368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/23/2022] Open
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Siuda J, Boczarska-Jedynak M, Budrewicz S, Dulski J, Figura M, Fiszer U, Gajos A, Gorzkowska A, Koziorowska-Gawron E, Koziorowski D, Krygowska-Wajs A, Rudzińska-Bar M, Sławek J, Ren X, Luo S, Martinez-Martin P, Stebbins G, Goetz CG, Opala G, Janik P, Koszewicz M, Leńska-Mieciek M, Michałowska M, Piaścik-Gromada M, Potasz-Kulikowska K, Śmiłowski M, Wasielewska A, Wójcik-Pędziwiatr M. Validation of the Polish version of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Neurol Neurochir Pol 2020; 54:416-425. [PMID: 32639019 DOI: 10.5603/pjnns.a2020.0049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2008, the Movement Disorders Society (MDS) published a new Unified Parkinson's Disease Rating Scale (MDS-UPDRS) as the official benchmark scale for Parkinson's Disease (PD). We have translated and validated the Polish version of the MDS-UPDRS, explored its dimensionality, and compared it to the original English one. METHODS The MDS-UPDRS was translated into Polish by a team of Polish investigators led by JS and GO. The back-translation was completed by colleagues fluent in both languages (Polish and English) who were not involved in the original translation, and was reviewed by members of the MDS Rating Scales Programme. Then the translated version of the MDS-UPDRS underwent cognitive pretesting, and the translation was modified based on the results. The final translation was approved as the Official Working Document of the MDS-UPDRS Polish version, and was tested on 355 Polish PD patients recruited at movement disorders centres all over Poland (at Katowice, Gdańsk, Łódź, Warsaw, Wrocław, and Kraków). Confirmatory and explanatory factor analyses were applied to determine whether the factor structure of the English version could be confirmed in the Polish version. RESULTS The Polish version of the MDS-UPDRS showed satisfactory clinimetric properties. The internal consistency of the Polish version was satisfactory. In the confirmatory factor analysis, all four parts had greater than 0.90 comparative fit index (CFI) compared to the original English MDS-UPDRS. Explanatory factor analysis suggested that the Polish version differed from the English version only within an acceptable range. CONCLUSIONS AND CLINICAL IMPLICATIONS The Polish version of the MDS-UPDRS meets the requirements to be designated as the Official Polish Version of the MDS-UPDRS, and is available on the MDS web page. We strongly recommend using the MDS-UPDRS instead of the UPDRS for research purposes and in everyday clinical practice.
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Cisneros E, Stebbins GT, Chen Q, Vu JP, Benadof CN, Zhang Z, Barbano RL, Fox SH, Goetz CG, Jankovic J, Jinnah HA, Perlmutter JS, Adler CH, Factor SA, Reich SG, Rodriguez R, Severt LL, Stover NP, Berman BD, Comella CL, Peterson DA. It's tricky: Rating alleviating maneuvers in cervical dystonia. J Neurol Sci 2020; 419:117205. [PMID: 33160248 DOI: 10.1016/j.jns.2020.117205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/12/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate hypothesized sources of error when quantifying the effect of the sensory trick in cervical dystonia (CD) with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS-2), test strategies to mitigate them, and provide guidance for future research on the sensory trick. METHODS Previous analyses suggested the sensory trick (or "alleviating maneuver", AM) item be removed from the TWSTRS-2 because of its poor clinimetric properties. We hypothesized three sources of clinimetric weakness for rating the AM: 1) whether patients were given sufficient time to demonstrate their AM; 2) whether patients' CD was sufficiently severe for detecting AM efficacy; and 3) whether raters were inadvertently rating the item in reverse of scale instructions. We tested these hypotheses with video recordings and TWSTRS-2 ratings by one "site rater" and a panel of five "video raters" for each of 185 Dystonia Coalition patients with isolated CD. RESULTS Of 185 patients, 23 (12%) were not permitted sufficient testing time to exhibit an AM, 23 (12%) had baseline CD too mild to allow confident rating of AM effect, and 1 site- and 1 video-rater each rated the AM item with a reverse scoring convention. When these confounds were eliminated in step-wise fashion, the item's clinimetric properties improved. CONCLUSIONS The AM's efficacy can contribute to measuring CD motor severity by addressing identified sources of error during its assessment and rating. Given the AM's sensitive diagnostic and potential pathophysiologic significance, we also provide guidance on modifications to how AMs can be assessed in future CD research.
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Tosin MHDS, Goetz CG, Luo S, Choi D, Stebbins GT. Item Response Theory Analysis of the MDS-UPDRS Motor Examination: Tremor vs. Nontremor Items. Mov Disord 2020; 35:1587-1595. [PMID: 32469456 DOI: 10.1002/mds.28110] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In PD, tremor severity behaves differently from other core motor features. However, the most commonly used assessment of overall motor severity, total MDS-UPDRS Motor Examination (Part 3) score, does not account for this distinction. OBJECTIVES To investigate the Motor Examination (Part 3) using Item Response Theory approaches focusing on sample-independent strategies that assess how well items measure latent models of PD motor severity. METHODS Data from 6,298 PD patients were analyzed with graded response model Item Response Theory approaches involving two analyses all 33 Part 3 items versus the 10 tremor items and 23 bradykinesia, rigidity, gait, and posture items considered separately. The strength of relationship between items and the latent measure of parkinsonian motor severity (discrimination parameter) and calculated thresholds (location parameters) were assessed using the mirt program implemented in R (R Foundation for Statistical Computing, Vienna, Austria). RESULTS Analyzing all Part 3 items together, nontremor items demonstrated good discrimination parameters (mean = 1.83 ± 0.37) and range of thresholds (-1.73 to +4.42), but tremor items had poor discrimination (mean = 0.52 ± 0.76) and thresholds (-0.69 to 14.29). Segregating nontremor from tremor items in two independent analyses provided markedly improved discrimination and location parameters for both. CONCLUSIONS MDS-UPDRS Part 3 tremor and nontremor items have very different relations to the construct of PD severity. Strongly improved clinimetric properties for Part 3 are obtained when tremor and nontremor items are considered separately. We suggest that evaluating PD motor severity, as an operationalized summary measure, is best attained through separate analyses with tremor and nontremor motor scores. © 2020 International Parkinson and Movement Disorder Society.
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Tosin MHS, Stebbins GT, Goetz CG, Santana RF, Leite MAA, Oliveira BGRB. Measuring Medication Adherence in Parkinson's Disease: A Systematic Review of Contributing Components in Rating Scales. Mov Disord Clin Pract 2020; 7:607-615. [PMID: 32775505 DOI: 10.1002/mdc3.13006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 12/21/2022] Open
Abstract
Background Poor medication adherence in chronic illnesses such as Parkinson's disease (PD) is a significant but potentially addressable issue if core components are systematically measured. Objective To assess whether rating scales used in PD adequately cover essential components of medication adherence. Methods We accessed 5 databases targeting articles published before October 2019 and using rating scales to measure medication adherence in PD. The ABC Taxonomy from the European Ascertaining Barriers to Compliance Consortium and World Health Organization recommendations were used as the evaluation standard of 5 essential adherence dimensions (patient-based, health system-based, social-based, therapy-based, and health condition-based), 3 phases (initiation, implementation, and discontinuation), and 2 factors (intentional and nonintentional). Results We screened 192 and selected 16 studies, collectively using 5 medication adherence rating scales. No scale covered all essential components of medication adherence (dimensions, phases, factors). The Morisky Medication Adherence Scales were the most frequently used (11 studies), but they measure only 2 dimensions and phases. The Stendal Adherence to Medication Score (used in 1 study) measured all phases but only 2 dimensions, and the Brief Medication Questionnaire (used in 3 studies) measured 3 dimensions and 2 phases. Distinctions between intentional and nonintentional factors were not completely considered in any scale. Conclusions Although multiple studies target medication adherence in PD, the used scales did not measure all recommended components, highlighting the need to develop a sensitive, specific, and comprehensive tool for measuring medication adherence among patients with PD.
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Faust-Socher A, Anis S, Kestenbaum M, Shabtai H, Taichman T, Bar David A, Ezra A, Peretz C, Rosenberg A, Brozgol M, Herman T, Stebbins GT, Goetz CG, Martínez-Martín P, Luo ST, Ren X, Giladi N, Gurevich T. Validation of the Hebrew Version of the Unified Dyskinesia Rating Scale. Neuroepidemiology 2020; 54:356-362. [PMID: 32541146 DOI: 10.1159/000507827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Unified Dyskinesia Rating Scale (UDysRS) is a well-established tool for producing comprehensive assessments of severity and disability associated with dyskinesia in patients with Parkinson's disease (PD). The scale was originally developed in English, and a broad international effort has been undertaken to develop and validate versions in additional languages. Our aim was to validate the Hebrew version of the UDysRS. METHODS We translated the UDysRS into Hebrew, back-translated it into English, and carried out cognitive pretesting. We then administered the scale to non-demented native Hebrew-speaking patients who fulfilled the Brain Bank diagnostic criteria for probable PD (n = 250). Data were compared to the Reference Standard data used for validating UDysRS translations. RESULTS The different portions of the Hebrew UDysRS showed high internal consistency (α ≥ 0.92). A confirmatory factor analysis in which we compared the Hebrew UDysRS to the Reference Standard version produced a comparative fit index (CFI) of 0.98, exceeding the threshold criterion of CFI > 0.9 indicating factor validity. A secondary exploratory factor analysis provided further support to the consistency between the factor structures of the Hebrew and Reference Standard versions of the UDysRS. CONCLUSION The UDysRS Hebrew version shows strong clinimetric properties and fulfills the criteria for designation as an official International Parkinson and Movement Disorder Society-approved translation for use in clinical and research settings.
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Diederich NJ, Uchihara T, Grillner S, Goetz CG. The Evolution-Driven Signature of Parkinson's Disease. Trends Neurosci 2020; 43:475-492. [PMID: 32499047 DOI: 10.1016/j.tins.2020.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/14/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
Abstract
In this review, we approach Parkinson's disease (PD) in the context of an evolutionary mismatch of central nervous system functions. The neurons at risk have hyperbranched axons, extensive transmitter release sites, display spontaneous spiking, and elevated mitochondrial stress. They function in networks largely unchanged throughout vertebrate evolution, but now connecting to the expanded human cortex. Their breakdown is favoured by longevity. At the cellular level, mitochondrial dysfunction starts at the synapses, then involves axons and cell bodies. At the behavioural level, network dysfunctions provoke the core motor syndrome of parkinsonism including freezing and failed gait automatization, and non-motor deficits including inactive blindsight and autonomic dysregulation. The proposed evolutionary re-interpretation of PD-prone cellular phenotypes and of prototypical clinical symptoms allows a new conceptual framework for future research.
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Goetz CG, Stebbins GT, Luo S. Movement Disorder Society-Unified Parkinson's Disease Rating Scale Use in the Covid-19 Era. Mov Disord 2020; 35:911. [PMID: 32320498 PMCID: PMC7264595 DOI: 10.1002/mds.28094] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/03/2022] Open
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Hill EJ, Goetz CG, Stebbins GT, Hagerman R, Ouyang B, Hall DA. Placebo Response in Fragile X-associated Tremor/Ataxia Syndrome. Mov Disord Clin Pract 2020; 7:298-302. [PMID: 32258228 PMCID: PMC7111569 DOI: 10.1002/mdc3.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder characterized by intention tremor, cerebellar ataxia, and executive dysfunction in carriers of a CGG repeat expansion premutation (55-200 repeats) in the fragile X mental retardation 1 (FMR1) gene. Given reports of poor insight in FXTAS, we postulated that patients with FXTAS would be less likely to exhibit placebo response. OBJECTIVE To analyze placebo response from the first randomized controlled trial in FXTAS that evaluated cognitive and motor outcomes after 1 year of treatment with memantine. METHODS Data from the placebo arm of the first randomized controlled trial in FXTAS were analyzed. There were 2 coprimary outcomes. Based on studies in Parkinson's disease, placebo responders were defined as individuals with an improvement of at least 50% in the coprimary outcomes. Improvements of 20% and 30% served as secondary cutoff values based on the suggested magnitude of placebo response in other movement disorders. RESULTS A total of 36 participants in the placebo group completed baseline and follow-up evaluations. The average age was 66 ± 7 years, and 60% were men. Average CGG repeat size was 86 ± 18. A total of 19 participants had stage 3 disease. Only 1 patient showed 50% improvement in both coprimary outcomes. At 30% and 20% improvement, there were 2 and 3 patients showing placebo response in the coprimary outcomes, respectively. CONCLUSIONS Patients with FXTAS exhibited low rates of placebo response in a randomized controlled trial. Further studies on the relationship between baseline insight and placebo responsivity are applicable to FXTAS and other disorders exhibiting cognitive impairment.
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Bernard BA, Carns D, Stebbins GT, Goldman JG, Goetz CG. Relationship of Movement Disorders Society-Unified Parkinson's Disease Rating Scale Nonmotor Symptoms to Cognitive Functioning in Patients with Parkinson's Disease. Mov Disord Clin Pract 2020; 7:279-283. [PMID: 32258225 DOI: 10.1002/mdc3.12902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 01/02/2020] [Accepted: 01/20/2020] [Indexed: 01/26/2023] Open
Abstract
Background Few studies assess the relationships between nonmotor aspects of experiences of daily living and cognitive functioning in Parkinson's disease (PD). Objective To evaluate the relationships among the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part I items and neuropsychological tests in PD.Methods: We assessed 151 PD patients with the MDS-UPDRS part I and a battery of cognitive tests focused on the following 5 cognitive domains: attention/working memory, executive functioning, recent memory, language, visuoperception. Raw scores for individual cognitive tests were transformed to z scores, and cognitive domain scores were calculated by averaging z scores within each domain. Individual items from the MDS-UPDRS part I were entered in a stepwise linear regression analysis assessing item contribution to cognitive domain scores. Results The MDS-UPDRS part I item scores for hallucinations and psychosis and light headedness on standing predicted attention/working memory domain scores (P = 0.004). These same item scores, along with apathy, depressed mood, and dopamine dysregulation syndrome, predicted executive functioning (P = 0.044). The apathy and dopamine dysregulation syndrome items predicted language (P = 0.006). In addition, the cognitive impairment and sleep items were predictors of recent memory (P = 0.031). None of the items were predictors of visuoperception (P = 0.006). Other part I items were not significantly related to cognitive domain scores. Conclusions Specific nonmotor MDS-UPDRS part I items, particularly mood, behavior, and autonomic-related items, exhibited significant relationships with cognitive domains. The highest number of items were predictive of the executive functioning domain, which is the hallmark cognitive dysfunction in PD.
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Chen Q, Vu JP, Cisneros E, Benadof CN, Zhang Z, Barbano RL, Goetz CG, Jankovic J, Jinnah HA, Perlmutter JS, Appelbaum MI, Stebbins GT, Comella CL, Peterson DA. Postural Directionality and Head Tremor in Cervical Dystonia. Tremor Other Hyperkinet Mov (N Y) 2020; 10:tre-10-745. [PMID: 32015932 PMCID: PMC6988138 DOI: 10.7916/tohm.v0.745] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/17/2019] [Indexed: 12/21/2022] Open
Abstract
Background Although abnormal head and neck postures are defining features of cervical dystonia (CD), head tremor (HT) is also common. However, little is known about the relationship between abnormal postures and HT in CD. Methods We analyzed clinical data and video recordings from 185 patients enrolled by the Dystonia Coalition. We calculated the likelihood of their HT and HT type ("regular" vs. "jerky") given directionality of abnormal head postures, disease duration, sex, and age. Results Patients with retrocollis were more likely to have HT than patients with anterocollis (X2 (1, N = 121) = 7.98, p = 0.005). There was no difference in HT likelihood given left or right turning in laterocollis and rotation. Patients with HT had longer disease duration (t(183) = 2.27, p = 0.024). There was no difference in age between patients with and without HT. In a logistic regression model, anterocollis/retrocollis direction (X2 (1, N = 121) = 6.04, p = 0.014), disease duration (X2 (1, N = 121) = 7.28, p = 0.007), and the interaction term between age and disease duration (X2 (1, N = 121) = 7.77, p = 0.005) collectively contributed to HT likelihood. None of the postural directionality or demographic variables were associated with differential likelihood of having regular versus jerky HT. Discussion We found that HT is more likely for CD patients with a specific directionality in their predominant posture. Our finding that CD patients with longer disease duration have a higher likelihood of HT also raises the question of whether HT becomes more likely over time in individual patients.
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Piot I, Schweyer K, Respondek G, Stamelou M, Sckopke P, Schenk T, Goetz CG, Stebbins GT, Höglinger GU, Gasser T, Hermann A, Höglinger G, Höllerhage M, Kimmich O, Klockgether T, Levin J, Machetanz G, Osterrath A, Palleis C, Prudlo J, Spottke A, Berg D, Bürk K, Claßen J, Eggers C, Greuel A, Grimm M, Hermann L, Iankova V, Jahn K, Jost W, Klietz M, Kühn A, Marxreiter F, Paschen S, Poetter‐Nerger M, Preisl M, Prilop L, Tönges L, Trenkwalder C, Warnecke T, Wegner F, Winkler J, Antonini A, P KP, L AL, Colosimo C, Compta Y, Corvol J, I LI, Höglinger GU, E AE, Litvan I, R HR, Nilsson C, Pantelyat A, Respondek G, Stamelou M. The Progressive Supranuclear Palsy Clinical Deficits Scale. Mov Disord 2020; 35:650-661. [DOI: 10.1002/mds.27964] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 01/09/2023] Open
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Witek NP, Goetz CG, Stebbins GT. Preface. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2020; 153:xi-xii. [PMID: 32563295 DOI: 10.1016/s0074-7742(20)30100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Ren X, Lin J, Luo S, Goetz CG, Stebbins GT, Cubo E. Successful use of the Unified Dyskinesia Rating Scale regardless of PD- or dyskinesia-duration. Parkinsonism Relat Disord 2019; 67:113-116. [PMID: 31495732 PMCID: PMC6858562 DOI: 10.1016/j.parkreldis.2019.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/14/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We assessed differential item functioning (DIF) in the Unified Dyskinesia Rating Scale (UDysRS) to evaluate bias risk from the duration of Parkinson's Disease (PD) and duration of dyskinesia. BACKGROUND Assessing DIF is a core validation step for rating scales. If DIF is present for an item, interpretation must consider influences from the tested covariates. DIF can be uniform or non-uniform, depending on the consistency of influence from the given covariate across all levels of dyskinesia. METHODS Using a large UDysRS database (N = 2313), uniform and non-uniform DIF related to the duration of PD and/duration of dyskinesia were tested. Unidimensionality of UDysRS was first confirmed using confirmatory factor analysis. DIF analysis was conducted using two independent latent models. DIF in an item was confirmed if both methods independently identified DIF at a significance level using Bonferroni correction. McFadden pseudo R^2 measured clinical relevancy of DIF magnitude (negligible, moderate, and large) for items identified with DIF, and items with DIF were considered clinically relevant if they exceeded a negligible designation. RESULTS Most items did not show uniform or non-uniform DIF based on PD and dyskinesia duration in isolation or in combination. For all items where DIF was identified, the magnitude statistic was in the negligible range (McFadden pseudo R^2 < 0.035) and the combined impact of multiple identified DIF items on UDysRS likewise did not exceed the negligible designation. CONCLUSION The absence of clinically relevant DIF suggests that the UDysRS can be applied across all patients regardless of their PD- or dyskinesia-duration.
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Schwarzschild MA, Macklin EA, Bakshi R, Battacharyya S, Logan R, Espay AJ, Hung AY, Bwala G, Goetz CG, Russell DS, Goudreau JL, Parashos SA, Saint-Hilaire MH, Rudolph A, Hare JM, Curhan GC, Ascherio A. Sex differences by design and outcome in the Safety of Urate Elevation in PD (SURE-PD) trial. Neurology 2019; 93:e1328-e1338. [PMID: 31484712 DOI: 10.1212/wnl.0000000000008194] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 05/10/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To investigate whether women and men with Parkinson disease (PD) differ in their biochemical and clinical responses to long-term treatment with inosine. METHODS The Safety of Urate Elevation in Parkinson's Disease (SURE-PD) trial enrolled 75 people with early PD and baseline serum urate below 6 mg/dL and randomized them to 3 double-blinded treatment arms: oral placebo or inosine titrated to produce mild (6.1-7.0 mg/dL) or moderate (7.1-8.0 mg/dL) serum urate elevation for up to 2 years. Parkinsonism, serum urate, and plasma antioxidant capacity were measured at baseline and repeatedly on treatment; CSF urate was assessed once, at 3 months. Here in secondary analyses results are stratified by sex. RESULTS Inosine produced an absolute increase in average serum urate from baseline that was 50% greater in women (3.0 mg/dL) than in men (2.0 mg/dL), consistent with expected lower baseline levels in women. Similarly, only among women was CSF urate significantly greater on mild or moderate inosine (+87% [p < 0.001] and +98% [p < 0.001], respectively) than on placebo (in contrast to men: +10% [p = 0.6] and +14% [p = 0.4], respectively). Women in the higher inosine dosing group showed a 7.0 Unified Parkinson's Disease Rating Scale (UPDRS) points/year lower rate of decline vs placebo (p = 0.01). In women, slower rates of UPDRS change were associated with greater increases in serum urate (r = -0.52; p = 0.001), and with greater increases in plasma antioxidant capacity (r = -0.44; p = 0.006). No significant associations were observed in men. CONCLUSIONS Inosine produced greater increases in serum and CSF urate in women compared to men in the SURE-PD trial, consistent with the study's design and with preliminary evidence for slower clinical decline in early PD among women treated with urate-elevating doses of inosine. CLINICALTRIALSGOV IDENTIFIER NCT00833690. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that inosine produced greater urate elevation in women than men and may slow PD progression in women.
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Evans AH, Okai D, Weintraub D, Lim SY, O'Sullivan SS, Voon V, Krack P, Sampaio C, Post B, Leentjens AFG, Martinez-Martin P, Stebbins GT, Goetz CG, Schrag A. Scales to assess impulsive and compulsive behaviors in Parkinson's disease: Critique and recommendations. Mov Disord 2019; 34:791-798. [PMID: 31136681 DOI: 10.1002/mds.27689] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/11/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022] Open
Abstract
Impulse control disorders (ICDs) and related impulsive and compulsive behaviors (together called ICBs) have been increasingly recognized in the context of Parkinson's disease (PD) and treatment. The International Parkinson's and Movement Disorder Society commissioned a task force to assess available clinical screening instruments and rating scales, including their clinimetric properties, make recommendations regarding their utility, and suggest future directions in scale development and validation. The literature was systematically searched for scales measuring a range of reported ICBs in PD. A scale was designated "recommended" if the scale had been employed in PD studies, been used beyond the group that developed it, and had adequate clinimetric data published for PD. Numerous diagnostic screening tools and severity rating scales were identified for a range of ICBs, including compulsive medication use, punding/hobbyism, walkabout, pathological gambling, hypersexuality, compulsive or binge eating, compulsive buying, reckless driving, compulsive exercise, pyromania, trichotillomania, hoarding, kleptomania, intermittent explosive disorder, and internet addiction. For screening across the range of ICBs (except compulsive medication use), the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease (QUIP) and QUIP-Rating Scale (QUIP-RS) are recommended, and for severity rating across the range of ICBs the QUIP-RS and the Ardouin Scale of Behavior in Parkinson's Disease are recommended. The Scale for Outcomes in Parkinson's Disease-Psychiatric Complications is recommended for rating of hypersexuality and the compulsive behaviors gambling/shopping. Further testing of established scales against gold standard diagnostic criteria is urgently required for all other individual ICBs in PD. © 2019 International Parkinson and Movement Disorder Society © 2019 International Parkinson and Movement Disorder Society.
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Vizcarra JA, Sánchez-Ferro Á, Maetzler W, Marsili L, Zavala L, Lang AE, Martinez-Martin P, Mestre TA, Reilmann R, Hausdorff JM, Dorsey ER, Paul SS, Dexheimer JW, Wissel BD, Fuller RLM, Bonato P, Tan AH, Bloem BR, Kopil C, Daeschler M, Bataille L, Kleiner G, Cedarbaum JM, Klucken J, Merola A, Goetz CG, Stebbins GT, Espay AJ. The Parkinson's disease e-diary: Developing a clinical and research tool for the digital age. Mov Disord 2019; 34:676-681. [PMID: 30901492 DOI: 10.1002/mds.27673] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/07/2019] [Accepted: 02/22/2019] [Indexed: 01/22/2023] Open
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Goetz CG. Developing Skills That Serve Our Journal, Your Colleagues as Potential Authors, and You. Mov Disord Clin Pract 2019; 6:200-201. [DOI: 10.1002/mdc3.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 11/06/2022] Open
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Diederich NJ, James Surmeier D, Uchihara T, Grillner S, Goetz CG. Parkinson's disease: Is it a consequence of human brain evolution? Mov Disord 2019; 34:453-459. [PMID: 30759321 PMCID: PMC6593760 DOI: 10.1002/mds.27628] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 12/15/2022] Open
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Hall DA, Stebbins GT, Jacquemont S, Berry-Kravis E, Goetz CG, Hagerman R, Zhang L, Leehey MA. Clinimetric Properties of the Fragile X-associated Tremor Ataxia Syndrome Rating Scale. Mov Disord Clin Pract 2019; 6:120-124. [PMID: 30838310 DOI: 10.1002/mdc3.12708] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/27/2018] [Accepted: 09/15/2018] [Indexed: 11/07/2022] Open
Abstract
Background There are currently no proven treatments for fragile X-associated tremor and ataxia syndrome (FXTAS). Validated outcome measures are needed in order to plan and conduct clinical trials to aid in the development of therapy. Methods This study examined the reliability and construct validity of the FXTAS Rating Scale. The study was conducted by using ratings from movement disorder specialists, who were blinded to gene status, on the FXTAS Rating Scale. Results In 295 premutation carriers with and without FXTAS, 33 scale items showed a high level of overall reliability, adequate item-to-total correlations and construct validity. Factor analysis revealed four components. Conclusions The result demonstrates that many items in the scale meet standard clinimetric criteria, but modification of the scale improved the overall utility.
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Hanson RE, Truesdell M, Stebbins GT, Weathers AL, Goetz CG. Telemedicine vs Office Visits in a Movement Disorders Clinic: Comparative Satisfaction of Physicians and Patients. Mov Disord Clin Pract 2018; 6:65-69. [PMID: 30746418 DOI: 10.1002/mdc3.12703] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 11/05/2022] Open
Abstract
Objective To compare patient and physician satisfaction between home-based telemedicine visits and office visits for follow-up care within a movement disorders program. Methods Patients were offered telemedicine visits as follow-up care. After telemedicine visits, a questionnaire of items along a 10-point Likert Scale (10 = most satisfied) assessed patient and overall physician satisfaction, comparing the experience to past in-office visits. Results Patients and physicians were highly satisfied with the telemedicine experience, both groups having median endorsement scores of 9.25 and 10.0, respectively (response range 6-10), and furthermore, favoring future telemedicine visits when feasible. Although some assessments could not be performed (postural stability, rigidity), physicians likewise favored having future telemedicine visits (median score 10, range 5.0-10). Conclusions This direct comparison of patient satisfaction with telemedicine visits to previously experienced office visits strongly supports telemedicine care, with patients highlighting convenience, time, and expense. Despite some limitations with telemedicine, physicians expressed highly rated quality-of-service provided.
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Hassan A, Dorsey ER, Goetz CG, Bloem BR, Guttman M, Tanner CM, Mari Z, Pantelyat A, Galifianakis NB, Bajwa JA, Gatto EM, Cubo E. Telemedicine Use for Movement Disorders: A Global Survey. Telemed J E Health 2018; 24:979-992. [DOI: 10.1089/tmj.2017.0295] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pavy-Le Traon A, Cotterill N, Amarenco G, Duerr S, Kaufmann H, Lahrmann H, Tison F, Wenning GK, Goetz CG, Poewe W, Sampaio C, Schrag A, Rascol O, Martinez-Martin P, Stebbins GT. Clinical Rating Scales for Urinary Symptoms in Parkinson Disease: Critique and Recommendations. Mov Disord Clin Pract 2018; 5:479-491. [PMID: 30515437 DOI: 10.1002/mdc3.12636] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/12/2018] [Accepted: 04/15/2018] [Indexed: 12/18/2022] Open
Abstract
Background The prevalence of lower urinary tract symptoms (LUTS) is high in Parkinson's disease (PD). These problems negatively affect quality of life and include both storage and voiding problems. The International Parkinson and Movement Disorder Society established a task force to review clinical rating scales/questionnaires for the assessment of urinary symptoms in PD. Methods According to prespecified criteria, these scales/questionnaires were classified as "Recommended" or "Recommended with caveats" when clinimetric properties were satisfactory for Recommended status but had not been assessed specifically in PD, "Suggested" or "Listed." These assessments were applied to rate scales as screening tools for the diagnosis of LUTS and for the rating of symptom severity. Results Among scales that included LUTS but focused on overall autonomic or non-motor symptoms in PD, no scale reached the clinimetric rigor to be designated as Recommended or Recommended with caveats, but some were Suggested for either diagnostic screening tools or severity measures. Among primary urological scales, most are well validated in urological setting, but none was validated specifically in PD. DAN-PSS (Danish PSS), ICIQ (International Consultation for Incontinence Questionnaire)-MLUTS (Male Lower Urinary Tract Symptoms), OABq, OABq-SF (ICIQ-OABqol), OAB-V8 (as screening tool), and OABSS (OAB Symptom Score) met criteria for Recommended with caveats. Conclusion The Task Force does not recommend the development of a new scale. However, all above-mentioned questionnaires need to be studied further and specifically validated in PD.
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