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. 2023;13(1):49-55.
doi: 10.3233/JPD-223501.

Nomogram to Predict the Probability of Functional Dependence in Early Parkinson's Disease

Dora Valent  1 , Florian Krismer  1 , Anna Grossauer  1 , Marina Peball  1 , Beatrice Heim  1 , Philipp Mahlknecht  1 , Atbin Djamshidian  1 , Werner Poewe  1 , Klaus Seppi  1
Affiliations

Nomogram to Predict the Probability of Functional Dependence in Early Parkinson's Disease

Dora Valent et al. J Parkinsons Dis. 2023.

Abstract

Background: Early identification of Parkinson's disease (PD) patients at risk for becoming functionally dependent is important for patient counseling. Several models describing the relationship between predictors and outcome have been reported, however, most of these require computer software for practical use.

Objective: Here we report the development of a risk nomogram allowing an approximate graphical computation of the risk of becoming functionally dependent in early PD.

Methods: We analyzed data form the Parkinson's Progression Markers Initiative cohort of newly diagnosed PD patients from baseline through the first 5 years of follow-up. Functional dependence was defined as a score < 80 on the Schwab & England Activities of Daily Living scale. A binary logistic model was developed to estimate the risk of functional dependence and based on the results, a nomogram for the prediction of functional dependence was drawn in order to provide an easy-to-use tool in clinical and academic settings as a part of personalized medicine approach to PD treatment.

Results: At baseline, three patients and over the five-year follow-up, 85 (22%) out of 395 patients were functionally dependent as scored by the Schwab & England Activities of Daily Living rating scale. The binary logistic model showed that clinical parameters such as MDS-UPDRS I (rater part), MDS-UPDRS II, and MDS-UPDRS axial motor score were significant predictors for functional dependence within 5 years.

Conclusion: We here provide an easy-to-use tool to estimate the risk of functional dependence in PD patients based on the MDS-UPDRS part I, II and axial motor score.

Keywords: Parkinson’s disease; early diagnosis; functional status; nomograms; prognosis; risk.

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Conflict of interest statement

The authors have no conflict of interest to report.

Figures

Fig. 1
Fig. 1
ROC curve analysis. The combination of the three predictors (MDS-UPDRS I Rater, MDS-UPDRS II, and axial motor score) yielded an overall accuracy of 78.5% and the area under the receiver-operating characteristics curve was 76.4%.
Fig. 2
Fig. 2
Nomogram for the prediction of functional dependence within 5 years. MDS-UPDRS, Movement Disorder Society-Unified Parkinson’s Disease Rating Scale; ADL, Activities of Daily Living. A nomogram model to predict functional dependence in early PD patients. Each associated factor is given a point value (total 100 points) which translates to a prognostic percentage of the likelihood that a patient will become functionally dependent within 5 years of diagnosis.
Fig. 3
Fig. 3
Example Nomogram. To read the nomogram, a vertical line is drawn for each variable of the patient, from the variable scale to the points scale. Then, the four values from the points scale are summed up to obtain total points. Finally, a vertical line is drawn from the total points scale to estimate risk of functional dependence within five years of PD diagnosis. For example, a patient with an MDS-UPDRS II score of 12, axial subscore of 14, MDS-UPDRS Part I score of 7 and Schwab & England score of 70 at the baseline visit would have a 91% estimated risk of becoming functionally dependent within 5 years of diagnosis.
See this image and copyright information in PMC

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