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Motor Subtypes of Parkinson Disease are Unstable Over Time (S48.002)

F. R. V. Coelln,E. Barr,A. Gruber-Baldini,S. Reich,M. Armstrong,L. Shulman

Published 2015 in Neurology

ABSTRACT

Objective : To determine whether classification of Parkinson disease (PD) patients into previously published motor subtypes changes over time. Background: Commonly-used PD motor subtypes include tremor-dominant (TD), postural instability/gait difficulty (PIGD) (or akinetic-rigid (AR)), and mixed. Understanding the stability of these subtypes over time is critical to establish their value in research, including investigations of biomarker-phenotype correlations. Design/Methods: Using our large longitudinal PD database, we performed two sets of analyses, applying three published algorithms of PD motor subtype classification (Jankovic(1990); Schiess(2000); Eggers(2011)): 1) consecutive cross-sectional analyses in 1,185 patients, determining the frequency of motor subtypes in 5 year-intervals of disease duration; 2) longitudinal analysis of 178 patients with 5-year follow-up data, comparing motor subtypes of patients at baseline (within 5 years of diagnosis) and at follow-up 蠅 5 years later. Results: Frequency of subtypes at baseline varied widely between the three subtype algorithms: 7-57[percnt] TD, 33-70[percnt] PIGD/AR, and 9-37[percnt] mixed, highlighting the differences between the three methods of classification. Across all three algorithms, cross-sectional analyses showed a marked decline of TD frequency with disease duration, from 7-44[percnt] ( Conclusions: Previously published motor subtypes of PD are not stable over time and vary widely in prevalence. Patients shift primarily from TD to PIGD/AR. Limited motor subtype fidelity should be taken into account when interpreting data of biomarker-motor subtype correlation. Study Supported by: Supported by a Clinical Training Research Fellowship grant by the American Academy of Neurology and the American Brain Foundation Disclosure: Dr. Von Coelln has nothing to disclose. Dr. Barr has nothing to disclose. Dr. Gruber-Baldini has nothing to disclose. Dr. Reich has received personal compensation for activities with Chelsea Therapeutics as a consultant. Dr. Reich has received royalty payments from Informa PLC. Dr. Reich has received research support from the National Institute of Neurological Disorders Dr. Armstrong has received personal compensation for activities with Abbvie, the Parkinson Study Group, the Huntington Study Group, CHDI Foundation, Inc., and InSightec as a consultant, investigator and/or sub-investigator. Dr. Shulman received research support from the NIH, Fox Foundation and Teva Pharmaceuticals.

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