A study of subtle motor signs in early Parkinson's disease§

Authors

  • Susanne A. Schneider MD, PhD,

    Corresponding author
    1. Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Lübeck, Lübeck, Germany
    Current affiliation:
    1. These authors contributed equally
    • Schilling Section of Clinical and Molecular Neurogenetics, Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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  • Laura Drude MD,

    Current affiliation:
    1. These authors contributed equally
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  • Meike Kasten MD,

  • Christine Klein MD,

  • Johann Hagenah MD


  • Funding agencies: This work was supported by grants from the Bosch Foundation (to S.A.S.), the German Research Foundation (DFG; to M.K.), the Bachmann-Strauss Dystonia Parkinson Foundation (to J.H.), the Volkswagen Foundation (Lichtenberg Grant; to C.K.), and the Hermann and Lilly Schilling Foundation (to C.K.).

  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • §

    Full financial disclosures and author roles may be found in the online version of this article.

Abstract

Background:

The UPDRS is the most widely used rating scale for Parkinson's disease (PD). However, subtle features of early disease stages may be missed.

Methods:

We studied 25 early PD patients using a newly compiled battery of motor tests focusing on subtle motor features. Focal dystonia patients (n = 31) and healthy individuals (n = 26) served as controls. Specifically, asymmetric shoulder null position and delayed shoulder shrugs, reduced arm swing, subtle tremor, and timed finger taps were assessed. Spiral drawings and writing were also studied.

Results:

With a total mean of 9.8 ± 4.9 (possible range: 0–94), PD patients scored significantly higher than dystonia patients (2.9 ± 2.0) and healthy controls (1.9 ± 2.0) (P < 0.001). Reduced arm swing and tremor of individual fingers best distinguished PD from the other groups.

Conclusions:

The battery was sensitive to detect subtle motor features missed by the UPDRS. For future revisions of an international motor score, further assessment of these items may be worthwhile. © 2012 Movement Disorder Society

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