Self-Report versus Clinician Examination in Early Parkinson's Disease

Abstract

Background: Evaluating the discrepancies between patient-reported measures and clinician examination has implications for formulating individual treatment regimens.

Objective: This study investigated the association between health outcomes and level of self-reported motor-related function impairment relative to clinician-examined motor signs.

Methods: Recently diagnosed PD patients were evaluated using the Parkinson's Progression Marker Initiative (PPMI, N = 420) and the PASADENA phase II clinical trial (N = 316). We calculated the average normalized difference between each participant's part II and III MDS-UPDRS (Movement Disorder Society Unified Parkinson's Disease Rating Scale) scores. Individuals with score differences <25th or >75th percentiles were labeled as low- and high-self-reporters, respectively (those between ranges were labeled intermediate-self-reporters). We compared a wide range of clinical/biomarker readouts among these three groups, using Kruskal-Wallis nonparametric and Pearson's χ² tests. Spearman's correlations were tested for associations between MDS-UPDRS subscales.

Results: In both cohorts, high-self-reporters reported the largest impairment/symptom experience for most motor and nonmotor patient-reported variables. By contrast, these high-self-reporters were similar to or less impaired on clinician-examined and biomarker measures. Patient-reported nonmotor symptoms on MDS-UPDRS part IB showed the strongest positive correlation with self-reported motor-related impairment (PPMI r_s = 0.54, PASADENA r_s = 0.52). This correlation was numerically stronger than the part II and clinician-examined MDS-UPDRS part III correlation (PPMI r_s = 0.38, PASADENA r_s = 0.28).

Conclusion: Self-reported motor-related impairments reflect not only motor signs/symptoms but also other self-reported nonmotor measures. This may indicate (1) a direct impact of nonmotor symptoms on motor-related functioning and/or (2) the existence of general response tendencies in how patients self-rate symptoms. Our findings suggest further investigation into the suitability of MDS-UPDRS II to assess motor-related impairments. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Keywords: Movement Disorder Society Unified Parkinson's Disease Rating Scale; Parkinson's disease; motor signs; motor symptoms.

FIG. 1

Inclusion chart for PPMI: among the de novo PD patients of PPMI, we selected those with Hoehn and Yahr stages 1 and 2 and those with available data on patient‐reported and clinician‐reported MDS‐UPDRS. PPMI, Parkinson's Progression Markers Initiative; PD, Parkinson's disease; SWEDD, Scans Without Evidence of Dopaminergic Deficit; MDS‐UPDRS, Movement Disorder Society Unified Parkinson Disease Rating Scale.

FIG. 2

Spearman's correlations show positive associations of MDS‐UPDRS (Movement Disorder Society Unified Parkinson's Disease Rating Scale) parts IA (left panel) and IB (right panel) with MDS‐UPDRS part II and part III.