Validation of the Portuguese version of the Movement Disorder Society non-motor rating scale (MDS-NMS) in Parkinson's disease

Thiago Cardoso Vale; Daniela Pereira Santos; Daniel Sabino de Oliveira; Pedro Renato de Paula Brandão; Danilo Assis Pereira; Raquel Bouça-Machado; Leonardo Oliveira Silva; Carlos Roberto de Mello Rieder; Egberto Reis Barbosa; Rubens Gisbert Cury; Jacy Bezerra Parmera; Hélio Afonso Ghizoni Teive; Matheus Gomes Ferreira; Henrique Ballalai Ferraz; Carolina Candeias da Silva; Vitor Tumas; Ana Luiza Nunes Cunha; Pedro Braga-Neto; Danielle Pessoa Lima; Marcus Vinícius Della Colleta; Débora Maia; Marco de Souza Fontana; Catarina N Damas; Patrícia Pita Lobo; Leonor Rebordão; Andreia D Magalhães; Ana Rita Peralta; Rita M Simões; Tânia Lampreia; Ana Graça Velon; Diogo Carneiro; Rita Raimundo; Miguel Gago; Alexandre Mendes; Nuno Vila Chã; Joana Damásio; Sara Costa; Rui Lopes; Ana Morgadinho; Tiago Mestre; Glenn T Stebbins; Sheng Luo; Christopher G Goetz; Joaquim J Ferreira; Francisco Cardoso; MDS-NMS Portuguese Validation Study Group

doi:10.1016/j.parkreldis.2025.107276

Validation of the Portuguese version of the Movement Disorder Society non-motor rating scale (MDS-NMS) in Parkinson's disease

Parkinsonism Relat Disord. 2025 Jan 13:132:107276. doi: 10.1016/j.parkreldis.2025.107276. Online ahead of print.

Authors

Thiago Cardoso Vale¹, Daniela Pereira Santos², Daniel Sabino de Oliveira², Pedro Renato de Paula Brandão³, Danilo Assis Pereira³, Raquel Bouça-Machado⁴, Leonardo Oliveira Silva², Carlos Roberto de Mello Rieder⁵, Egberto Reis Barbosa⁶, Rubens Gisbert Cury⁶, Jacy Bezerra Parmera⁶, Hélio Afonso Ghizoni Teive⁷, Matheus Gomes Ferreira⁷, Henrique Ballalai Ferraz⁸, Carolina Candeias da Silva⁸, Vitor Tumas⁹, Ana Luiza Nunes Cunha⁹, Pedro Braga-Neto¹⁰, Danielle Pessoa Lima¹¹, Marcus Vinícius Della Colleta¹², Débora Maia¹³, Marco de Souza Fontana¹³, Catarina N Damas¹⁴, Patrícia Pita Lobo¹⁵, Leonor Rebordão¹⁴, Andreia D Magalhães¹⁵, Ana Rita Peralta¹⁴, Rita M Simões¹⁶, Tânia Lampreia¹⁷, Ana Graça Velon¹⁸, Diogo Carneiro¹⁸, Rita Raimundo¹⁸, Miguel Gago¹⁹, Alexandre Mendes²⁰, Nuno Vila Chã²⁰, Joana Damásio²⁰, Sara Costa²⁰, Rui Lopes²⁰, Ana Morgadinho²¹, Tiago Mestre²², Glenn T Stebbins²³, Sheng Luo²⁴, Christopher G Goetz²³, Joaquim J Ferreira⁴, Francisco Cardoso¹³; MDS-NMS Portuguese Validation Study Group

Affiliations

¹ Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil. Electronic address: thiago.vale@ufjf.br.
² Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
³ Instituto Brasileiro de Neuropsicologia e Ciências Cognitivas, Brasília, Distrito Federal, Brazil.
⁴ CNS | Campus Neurológico, Torres Vedras, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Lisbon, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
⁵ Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil.
⁶ Movement Disorders Center, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
⁷ Hospital de Clínicas - Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
⁸ Faculdade de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
⁹ Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo State, Brazil.
¹⁰ Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil; Center of Health Sciences, Universidade Estadual do Ceará, Brazil.
¹¹ Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
¹² Universidade do Estado de Amazonas, Manaus, Amazonas, Brazil.
¹³ Movement Disorders Unit, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
¹⁴ CNS | Campus Neurológico, Torres Vedras, Portugal.
¹⁵ CNS | Campus Neurológico, Torres Vedras, Portugal; Department of Neurosciences and Mental Health, Neurology Department, ULS de Santa Maria, Lisbon, Portugal.
¹⁶ CNS | Campus Neurológico, Torres Vedras, Portugal; Neurology Department, ULS de Loures-Odivelas, Lisbon, Portugal.
¹⁷ Neurology Department, ULS de Loures-Odivelas, Lisbon, Portugal.
¹⁸ Neurology Department, ULS de Trás-os-Montes e Alto Douro, Vila Real, Portugal.
¹⁹ Neurology Department, ULS Alto Ave, Portugal.
²⁰ Neurology Department, Centro Hospitalar Universitário de Santo António, ULS Santo António, Porto, Portugal.
²¹ Hospital da Luz Coimbra, Coimbra, Portugal.
²² Parkinson's Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Institute, Ottawa, Canada.
²³ Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
²⁴ Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA.

PMID: 39848139
DOI: 10.1016/j.parkreldis.2025.107276

Abstract

Background: The Movement Disorder Society Non-Motor Rating Scale (MDS-NMS) serves as a comprehensive clinical assessment tool for non-motor symptoms in Parkinson's disease (PD) OBJECTIVES: This study aims to validate the Portuguese version of the MDS-NMS, addressing the critical need for culturally adapted rating scales in Portuguese-speaking populations.

Methods: This multicenter, cross-sectional study engaged native Portuguese-speaking PD patients from 16 Movement Disorders Centers across Portugal and Brazil. We conducted a meticulous translation process into Portuguese, including forward-backward translation and cognitive pretesting. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were conducted to evaluate the psychometric properties and structural validity of the Portuguese version in comparison to the original English version. Tertiary analyses assessed the acceptability and reliability of domain scores within the cohort.

Results: The scale was administered to 386 PD Portuguese-speaking patients. CFA, conducted with a final sample of 303 participants, confirmed that the Portuguese version maintained a factor structure consistent with the English original, with Comparative Fit Index (CFI) values meeting or exceeding the 0.90 threshold across all subscales. High CFI values in domains such as Depression, Psychosis, and Cognition underscored the robustness of the translation. EFA revealed generally strong item-factor relationships, although domains like Gastrointestinal and Non-Motor Fluctuations exhibited more complex structures. Reliability analyses demonstrated strong internal consistency, with Cronbach's α ranging from 0.50 to 0.86 across domains, further corroborated by McDonald's ω and Greatest Lower Bound values.

Conclusions: The Portuguese version of the MDS-NMS demonstrates psychometric properties and structural validity that closely aligns with the original version.

Keywords: Clinimetrics; MDS-NMS; Parkinson's disease; Rating scale; Validation.