Chaudhuri's Dashboard of Vitals in Parkinson's syndrome: an unmet need underpinned by real life clinical tests

Abstract

We have recently published the notion of the "vitals" of Parkinson's, a conglomeration of signs and symptoms, largely nonmotor, that must not be missed and yet often not considered in neurological consultations, with considerable societal and personal detrimental consequences. This "dashboard," termed the Chaudhuri's vitals of Parkinson's, are summarized as 5 key vital symptoms or signs and comprise of (a) motor, (b) nonmotor, (c) visual, gut, and oral health, (d) bone health and falls, and finally (e) comorbidities, comedication, and dopamine agonist side effects, such as impulse control disorders. Additionally, not addressing the vitals also may reflect inadequate management strategies, leading to worsening quality of life and diminished wellness, a new concept for people with Parkinson's. In this paper, we discuss possible, simple to use, and clinically relevant tests that can be used to monitor the status of these vitals, so that these can be incorporated into clinical practice. We also use the term Parkinson's syndrome to describe Parkinson's disease, as the term "disease" is now abandoned in many countries, such as the U.K., reflecting the heterogeneity of Parkinson's, which is now considered by many as a syndrome.

Keywords: Parkinson’s disease; dashboard; gut; motor; nonmotor; oral; vision; vitals.

Figure 1

A summary of the Chaudhuri’s Dashboard of Vitals in Parkinson’s, adapted from Chaudhuri et al. (6).

Figure 2

Chaudhuri’s Dashboard of Vitals clinical tools. This figure summarizes discussed clinical tools when applied to the Dashboard of Vitals in Parkinson’s disease. The figure splits the tools into four categories; (1) clinical tools available for clinicians, these are currently available tools with good evidence to application to real-clinical practice; (2) clinical tools potentially available, these are tools which may limited due to resources and should be considered with careful consideration depending on the clinical indications; (3) clinical tools for future consideration, these are tools which may be available or currently being developed but are not solely able to be applied without further evidence for their application in clinical practice; and (4) clinical questionnaires and scales, these are tools which allow for screening and progression monitoring in clinical practice. ABPM, ambulatory blood pressure monitor; ADS, anticholinergic drug scale; BMI, body mass index; CCM, corneal confocal microscopy; CPS, co-morbidities polypharmacy scale; CT, computerized tomography; DaTScan, presynaptic dopamine transporter single-photon emission computerized tomography; DBI-Ach, burden index anticholinergic component; DEXA, dual-energy X-ray absorptiometry; EEG, electroencephalogram; ERG, electroretinography; FEES, fibreoptic endoscopic evaluation of swallowing; FRAX, fracture risk assessment tool; GIDS, gastrointestinal dysfunction scale; H&Y, Hoehn and Yahr; HBA1C, glycated hemoglobin; HP, helicobacter pylori; ICD, impulsive control disorder; MDS, movement disorder society; MIBG, 123I-metaiodobenzylguandine; MRI, magnetic resonance imaging; MSLT, multiple sleep latency tests; NM, neuromelanin; NMS, nonmotor symptoms; OCT, optical coherence tomography; P gingivalis, porphyromonas gingivalis; PD, Parkinson’s disease; PSG, polysomnography; QUEST, questionnaire; SIBO, small intestinal bacterial overgrowth; SN, substantia nigra; SWI, susceptibility weighted imaging; TCS, transcranial sonography; UPDRS, unified Parkinson’s disease rating scale; VEMP, vestibular-evoked myogenic potential; VEP, visual evoked potential; VFSS, videofluoroscopic swallowing study; Vit, vitamin; XR, x-ray.