Parkinsonism in multiple system atrophy: Natural history, severity (UPDRS‐III), and disability assessment compared with Parkinson's disease
Identifieur interne : 004357 ( Main/Exploration ); précédent : 004356; suivant : 004358Parkinsonism in multiple system atrophy: Natural history, severity (UPDRS‐III), and disability assessment compared with Parkinson's disease
Auteurs : François Tison [France] ; Farid Yekhlef [France] ; Virginie Chrysostome [France] ; Eric Balestre [France] ; Niall P. Quinn [Royaume-Uni] ; Werner Poewe [Autriche] ; Gregor K. Wenning [Autriche]Source :
- Movement Disorders [ 0885-3185 ] ; 2002-07.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Adulte.
English descriptors
- KwdEn :
- Activities of Daily Living (classification), Adult, Aged, Antiparkinson Agents (adverse effects), Antiparkinson Agents (therapeutic use), Comparative study, Differential diagnostic, Disability, Disability Evaluation, Evaluation scale, Factor analysis, Female, Handicap, Humans, Levodopa (adverse effects), Levodopa (therapeutic use), Male, Mental Status Schedule, Middle Aged, Multiple System Atrophy (classification), Multiple System Atrophy (diagnosis), Multiple System Atrophy (drug therapy), Multiple system atrophy, Neurologic Examination (drug effects), Neurologic Examination (statistics & numerical data), Parkinson disease, Parkinson's disease, Parkinsonian Disorders (classification), Parkinsonian Disorders (diagnosis), Parkinsonian Disorders (drug therapy), Parkinsonism, Psychometrics, Reproducibility of Results, Test validation, UPDRS‐III, dependency, factor analysis, internal consistency, multiple system atrophy, parkinsonism, severity.
- MESH :
- chemical , adverse effects : Antiparkinson Agents, Levodopa.
- classification : Activities of Daily Living, Multiple System Atrophy, Parkinsonian Disorders.
- diagnosis : Multiple System Atrophy, Parkinsonian Disorders.
- drug effects : Neurologic Examination.
- drug therapy : Multiple System Atrophy, Parkinsonian Disorders.
- statistics & numerical data : Neurologic Examination.
- chemical , therapeutic use : Antiparkinson Agents, Levodopa.
- Aged, Disability Evaluation, Female, Humans, Male, Mental Status Schedule, Middle Aged, Reproducibility of Results.
Abstract
We analyzed parkinsonian features in multiple system atrophy (MSA) compared with age‐ and disease duration‐matched Parkinson's disease (PD) patients, and assessed the applicability of the Unified Parkinson's Disease Rating Scale (UPDRS) ‐III motor scale as a means of rating their severity. Cross‐sectional analysis of parkinsonism was done using UPDRS‐III, International Cerebellar Atatia Rating Scale, and disability scales (Hoehn and Yahr [H&A], Schwab and England, Katz and Lawton) in 50 unselected MSA patients and in 50 matched PD patients. At symptom onset, falls occurred 10 times more frequently in MSA, whereas limb tremor was 10 times more common in PD. At first visit (10.2 months), hemiparkinsonism and pill‐rolling rest tremor were less common in MSA. Hypomimia, atypical rest, postural or action tremor, as well as postural instability were more frequent in MSA. At study examination (62.4 months), parkinsonian signs in MSA patients were more frequently symmetrical and associated with axial rigidity, antecollis and postural instability. A levodopa response of >50% was seen in <10% of MSA patients. Modified H&Y stages (3.2 ± 1.3 vs. 2.2 ± 0.78) and UPDRS‐III scores (48.14 ± 19.5 vs. 31.74 ± 12.9) were significantly (P = 0.0001) higher in MSA. The internal consistency of the UPDRS‐III was fair in MSA patients (Cronbach's α >0.90), and correlated well with marked dependency on the Schwab and England and Katz and Lawton scales. Factor structure analysis of UPDRS‐III in MSA showed five clinically distinct subscores accounting for 74% of the variance, differing from PD by the dependency of the face–speech and limb bradykinesia items and independence of the postural–action tremor from the rest tremor items. There was a significant correlation (R2 = 0.70, P = 0.001) between ICARS ataxia and UPDRS‐III scores in MSA patients. Results confirm a distinct profile of parkinsonism in MSA and greater severity and disability compared with PD. It also indicates that the UPDRS‐III provides a useful severity measure of parkinsonism in MSA, albeit contaminated by additional cerebellar dysfunction. © 2002 Movement Disorder Society
Url:
DOI: 10.1002/mds.10171
Affiliations:
- Autriche, France, Royaume-Uni
- Angleterre, Grand Londres, Tyrol (Land)
- Bordeaux, Innsbruck, Londres
- Université de médecine d'Innsbruck
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Le document en format XML
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<term>Antiparkinson Agents (therapeutic use)</term>
<term>Comparative study</term>
<term>Differential diagnostic</term>
<term>Disability</term>
<term>Disability Evaluation</term>
<term>Evaluation scale</term>
<term>Factor analysis</term>
<term>Female</term>
<term>Handicap</term>
<term>Humans</term>
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<term>Levodopa (therapeutic use)</term>
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<term>Neurologic Examination (drug effects)</term>
<term>Neurologic Examination (statistics & numerical data)</term>
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<term>Parkinson's disease</term>
<term>Parkinsonian Disorders (classification)</term>
<term>Parkinsonian Disorders (diagnosis)</term>
<term>Parkinsonian Disorders (drug therapy)</term>
<term>Parkinsonism</term>
<term>Psychometrics</term>
<term>Reproducibility of Results</term>
<term>Test validation</term>
<term>UPDRS‐III</term>
<term>dependency</term>
<term>factor analysis</term>
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<front><div type="abstract" xml:lang="en">We analyzed parkinsonian features in multiple system atrophy (MSA) compared with age‐ and disease duration‐matched Parkinson's disease (PD) patients, and assessed the applicability of the Unified Parkinson's Disease Rating Scale (UPDRS) ‐III motor scale as a means of rating their severity. Cross‐sectional analysis of parkinsonism was done using UPDRS‐III, International Cerebellar Atatia Rating Scale, and disability scales (Hoehn and Yahr [H&A], Schwab and England, Katz and Lawton) in 50 unselected MSA patients and in 50 matched PD patients. At symptom onset, falls occurred 10 times more frequently in MSA, whereas limb tremor was 10 times more common in PD. At first visit (10.2 months), hemiparkinsonism and pill‐rolling rest tremor were less common in MSA. Hypomimia, atypical rest, postural or action tremor, as well as postural instability were more frequent in MSA. At study examination (62.4 months), parkinsonian signs in MSA patients were more frequently symmetrical and associated with axial rigidity, antecollis and postural instability. A levodopa response of >50% was seen in <10% of MSA patients. Modified H&Y stages (3.2 ± 1.3 vs. 2.2 ± 0.78) and UPDRS‐III scores (48.14 ± 19.5 vs. 31.74 ± 12.9) were significantly (P = 0.0001) higher in MSA. The internal consistency of the UPDRS‐III was fair in MSA patients (Cronbach's α >0.90), and correlated well with marked dependency on the Schwab and England and Katz and Lawton scales. Factor structure analysis of UPDRS‐III in MSA showed five clinically distinct subscores accounting for 74% of the variance, differing from PD by the dependency of the face–speech and limb bradykinesia items and independence of the postural–action tremor from the rest tremor items. There was a significant correlation (R2 = 0.70, P = 0.001) between ICARS ataxia and UPDRS‐III scores in MSA patients. Results confirm a distinct profile of parkinsonism in MSA and greater severity and disability compared with PD. It also indicates that the UPDRS‐III provides a useful severity measure of parkinsonism in MSA, albeit contaminated by additional cerebellar dysfunction. © 2002 Movement Disorder Society</div>
</front>
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