Parkinson disease clinical subtypes: key features & clinical milestones
Objectives Based on multi‐domain classification of Parkinson disease (PD) subtypes, we sought to determine the key features that best differentiate subtypes and the utility of PD subtypes to predict clinical milestones. Methods Prospective cohort of 162 PD participants with ongoing, longitudinal fol...
Saved in:
Published in | Annals of clinical and translational neurology Vol. 7; no. 8; pp. 1272 - 1283 |
---|---|
Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
John Wiley & Sons, Inc
01.08.2020
John Wiley and Sons Inc Wiley |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | Objectives
Based on multi‐domain classification of Parkinson disease (PD) subtypes, we sought to determine the key features that best differentiate subtypes and the utility of PD subtypes to predict clinical milestones.
Methods
Prospective cohort of 162 PD participants with ongoing, longitudinal follow‐up. Latent class analysis (LCA) delineated subtypes based on score patterns across baseline motor, cognitive, and psychiatric measures. Discriminant analyses identified key features that distinguish subtypes at baseline. Cox regression models tested PD subtype differences in longitudinal conversion to clinical milestones, including deep brain stimulation (DBS), dementia, and mortality.
Results
LCA identified distinct subtypes: “motor only” (N = 63) characterized by primary motor deficits; “psychiatric & motor” (N = 17) characterized by prominent psychiatric symptoms and moderate motor deficits; “cognitive & motor” (N = 82) characterized by impaired cognition and moderate motor deficits. Depression, executive function, and apathy best discriminated subtypes. Since enrollment, 22 had DBS, 48 developed dementia, and 46 have died. Although there were no subtype differences in rate of DBS, dementia occurred at a higher rate in the “cognitive & motor” subtype. Surprisingly, mortality risk was similarly elevated for both “cognitive & motor” and “psychiatric & motor” subtypes compared to the “motor only” subtype (relative risk = 3.15, 2.60).
Interpretation
Psychiatric and cognitive features, rather than motor deficits, distinguish clinical PD subtypes and predict greater risk of subsequent dementia and mortality. These results emphasize the value of multi‐domain assessments to better characterize clinical variability in PD. Further, differences in dementia and mortality rates demonstrate the prognostic utility of PD subtypes. |
---|---|
Bibliography: | Funding Information Support for this work was provided by grants from NINDS (NS097437, NS075321, NS41509, NS058714, NS48924, P30 NS048056) and NIH NCRR (UL1RR024992); American Parkinson Disease Association (APDA) Advanced Research Center for PD at WUSTL; Greater St. Louis Chapter of the APDA; Oertli Fund; Barnes‐Jewish Hospital Foundation (BJHF) (Elliot Stein Family Fund & PD Research Fund), and Paula C and Rodger O Riney Foundation. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 2328-9503 2328-9503 |
DOI: | 10.1002/acn3.51102 |