Denoised MDS-UPDRS Part-III Scores Yield New Patterns of Progression Heterogeneity in Early Stage Parkinson's Disease

Parkinson's Disease (PD) Motor Scores (MDS-UPDRS Part III) are quite noisy. This paper proposes a new methodology for processing these scores by first denoising the scores to enhance the underlying progression signal, and then conducting a high-dimensional analysis which does not sum the scores into a total movement score. The analysis gives novel insights into PD progression heterogeneity: it reveals that the heterogeneity is continuously variable rather than clustered into "subtypes" and that the variability is along two easily understood axes. This analysis also resolves some of the discrepancies in previously reported progression subtypes. Finally, the analysis reveals that patient-specific progression cannot be predicted from baseline using only MDS-UPDRS Part III scores.