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Motor phenotype classification in moderate to advanced PD in BioFIND study
Lan Luo1, Howard Andrews2, Roy N Alcalay3
1Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Parkinsonism & Related Disorders
|July 1, 2019
Summary
Parkinson's disease motor subtypes, like tremor-dominant and PIGD, are not fixed. They can change with disease progression and dopaminergic treatment, especially with tremor improvement.
Area of Science:
- Neurology
- Movement Disorders
- Neurodegenerative Diseases
Background:
- Parkinson's disease (PD) is characterized by motor phenotypes, including tremor-dominant (TD), postural instability and gait difficulty (PIGD)-dominant, and indeterminate (IND) subtypes.
- These subtypes are linked to distinct cognitive and motor outcomes, as well as biomarker profiles.
- The stability of these motor classifications during disease progression and in response to treatment remains unclear.
Purpose of the Study:
- To investigate the dynamic changes in motor subtype ratios in Parkinson's disease.
- To determine if motor subtype classifications evolve with disease progression and dopaminergic therapy.
Main Methods:
- Analysis of motor subtype ratios using chi-square tests in the BioFIND study (off and on medication states).
- Longitudinal evaluation of motor subtype changes over five years in the Parkinson's Progression Markers Initiative (PPMI) study.
- Assessment of subtype shifts in relation to dopaminergic treatment and disease advancement.
Main Results:
- Motor subtypes (PIGD and TD) in moderate to advanced PD patients shifted with dopaminergic treatment.
- Improvement in tremor was a key factor in TD to other subtype transitions (25.4%).
- All PD subgroups showed a decreased subtype ratio with disease progression; TD subgroup showed a significant decline with dopaminergic agents, more pronounced with disease advancement.
Conclusions:
- Motor subtypes in Parkinson's disease are not static and can change over time with disease progression and treatment.
- Tremor improvement significantly influences motor phenotype transitions.
- There is a need for a more stable PD subtype classification system based on underlying biological differences.
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