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. 2021 Dec 28;12(1):55.
doi: 10.3390/diagnostics12010055.

MNCD: A New Tool for Classifying Parkinson's Disease in Daily Clinical Practice

Diego Santos García  1   2 , María Álvarez Sauco  3 , Matilde Calopa  4 , Fátima Carrillo  5   6 , Francisco Escamilla Sevilla  7 , Eric Freire  3   8 , Rocío García Ramos  9 , Jaime Kulisevsky  6   10 , Juan Carlos Gómez Esteban  11 , Inés Legarda  12 , María Rosario Isabel Luquín  13 , Juan Carlos Martínez Castrillo  14 , Pablo Martínez-Martin  6 , Irene Martínez-Torres  15 , Pablo Mir  5   6 , Ángel Sesar Ignacio  16
Affiliations

MNCD: A New Tool for Classifying Parkinson's Disease in Daily Clinical Practice

Diego Santos García et al. Diagnostics (Basel). .

Abstract

Background and objective: Parkinson's disease (PD) is a clinically heterogeneous disorder in which the symptoms and prognosis can be very different among patients. We propose a new simple classification to identify key symptoms and staging in PD. Patients and Methods: Sixteen movement disorders specialists from Spain participated in this project. The classification was consensually approved after a discussion and review process from June to October 2021. The TNM classification and the National Institutes of Health Stroke Scale (NIHSS) were considered as models in the design. Results: The classification was named MNCD and included 4 major axes: (1) motor symptoms; (2) non-motor symptoms; (3) cognition; (4) dependency for activities of daily living (ADL). Motor axis included 4 sub-axes: (1) motor fluctuations; (2) dyskinesia; (3) axial symptoms; (4) tremor. Four other sub-axes were included in the non-motor axis: (1) neuropsychiatric symptoms; (2) autonomic dysfunction; (3) sleep disturbances and fatigue; (4) pain and sensory disorders. According to the MNCD, 5 stages were considered, from stage 1 (no disabling motor or non-motor symptoms with normal cognition and independency for ADL) to 5 (dementia and dependency for basic ADL). Conclusions: A new simple classification of PD is proposed. The MNCD classification includes 4 major axes and 5 stages to identify key symptoms and monitor the evolution of the disease in patients with PD. It is necessary to apply this proof of concept in a properly designed study.

Keywords: Parkinson’s disease; cognition; dependency; motor symptoms; non-motor symptoms.

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Conflict of interest statement

The authors declare no conflict of interest. The authors did not receive any financial compensation for their participation in this project.

Figures

Figure 1
Figure 1
Flow chart on the phases and objectives of the project. PD, Parkinson’s disease.
Figure 2
Figure 2
MNCD PD classification, showing the 4 major axis with their sub-axes and stages from 1 to 5. In Staging, an arrow with the same color as in the upper part indicates that there is a relevant symptomatology regarding the axis. For axes 3 and 4, light color indicates milder symptoms (mild cognitive impairment for axis 3 and dependency for instrumental ADL for axis 4) and dark color for a more severe affectation (dementia for axis 3 and dependency for ADL for axis 4). When the arrow is blue, it indicates that there may or may not be relevant symptoms related to the axis. *, it is considered by itself a single axis (without sub-axes) with excluding options. ADL, activities of daily living.
Figure 3
Figure 3
Three examples about the use of the MNCD classification are shown in PD patients with very different characteristics and outcomes (age from symptoms onset, phenotype, etc.). Example 1 represents a patient who developed dementia in the long-term; example 2, an elderly woman at symptoms onset who developed dementia and functional dependency in the short-term; example 3, a very young patient with an asymmetric tremor dominant benign form who improved after intervention and remained very stable after several years of evolution. FOG, freezing of gait; PD, Parkinson’s disease.
See this image and copyright information in PMC

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