Self-Report versus Clinician Examination in Early Parkinson's Disease

Sheida Zolfaghari; Alessandra E Thomann; Natalia Lewandowski; Dylan Trundell; Florian Lipsmeier; Gennaro Pagano; Kirsten I Taylor; Ronald B Postuma

doi:10.1002/mds.28884

Self-Report versus Clinician Examination in Early Parkinson's Disease

Mov Disord. 2022 Mar;37(3):585-597. doi: 10.1002/mds.28884. Epub 2021 Dec 13.

Authors

Sheida Zolfaghari^{1

2}, Alessandra E Thomann³, Natalia Lewandowski⁴, Dylan Trundell⁵, Florian Lipsmeier⁶, Gennaro Pagano^{3

7}, Kirsten I Taylor³, Ronald B Postuma^{2

8

9}

Affiliations

¹ Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada.
² Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
³ Roche Pharma Research and Early Development, Neuroscience and Rare Diseases Discovery and Translational Area, Basel, Switzerland.
⁴ Faculty of Science, McGill University, Montreal, Quebec, Canada.
⁵ Roche Products Limited, Welwyn Garden City, United Kingdom.
⁶ Roche Pharma Research and Early Development, pRED Informatics, Roche Innovation Center, Basel, Switzerland.
⁷ King's College London, London, United Kingdom.
⁸ Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
⁹ Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.

Abstract

Background: Evaluating the discrepancies between patient-reported measures and clinician examination has implications for formulating individual treatment regimens.

Objective: This study investigated the association between health outcomes and level of self-reported motor-related function impairment relative to clinician-examined motor signs.

Methods: Recently diagnosed PD patients were evaluated using the Parkinson's Progression Marker Initiative (PPMI, N = 420) and the PASADENA phase II clinical trial (N = 316). We calculated the average normalized difference between each participant's part II and III MDS-UPDRS (Movement Disorder Society Unified Parkinson's Disease Rating Scale) scores. Individuals with score differences <25th or >75th percentiles were labeled as low- and high-self-reporters, respectively (those between ranges were labeled intermediate-self-reporters). We compared a wide range of clinical/biomarker readouts among these three groups, using Kruskal-Wallis nonparametric and Pearson's χ² tests. Spearman's correlations were tested for associations between MDS-UPDRS subscales.

Results: In both cohorts, high-self-reporters reported the largest impairment/symptom experience for most motor and nonmotor patient-reported variables. By contrast, these high-self-reporters were similar to or less impaired on clinician-examined and biomarker measures. Patient-reported nonmotor symptoms on MDS-UPDRS part IB showed the strongest positive correlation with self-reported motor-related impairment (PPMI r_s = 0.54, PASADENA r_s = 0.52). This correlation was numerically stronger than the part II and clinician-examined MDS-UPDRS part III correlation (PPMI r_s = 0.38, PASADENA r_s = 0.28).

Conclusion: Self-reported motor-related impairments reflect not only motor signs/symptoms but also other self-reported nonmotor measures. This may indicate (1) a direct impact of nonmotor symptoms on motor-related functioning and/or (2) the existence of general response tendencies in how patients self-rate symptoms. Our findings suggest further investigation into the suitability of MDS-UPDRS II to assess motor-related impairments. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Keywords: Movement Disorder Society Unified Parkinson's Disease Rating Scale; Parkinson's disease; motor signs; motor symptoms.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Mental Status and Dementia Tests
Parkinson Disease* / diagnosis
Self Report
Severity of Illness Index