Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS)

El objetivo de este estudio fue determinar la presencia de manifestaciones de la enfermedad de Parkinson (EP), su distribución según subtipos motores y las relaciones con la calidad de vida relacionada con la salud (CdV) utilizando la Escala Compuesta de la Enfermedad de Parkinson patrocinada por la...

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Autores:: Hurtado González, Carlos Alberto
Balestrino, Roberta
Stocchi, Fabrizio
Giada Radicati, Fabiana
Chaudhuri, Ray
Rodriguez Blazquez, Carmen
Martinez Martin, Pablo
The PDCS European Study Group

Tipo de recurso:: Article of investigation

Fecha de publicación:: 2019

Institución:: Universidad Cooperativa de Colombia

Repositorio:: Repositorio UCC

Idioma:

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network_acronym_str	COOPER2
network_name_str	Repositorio UCC
repository_id_str
dc.title.spa.fl_str_mv	Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS)
title	Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS)
spellingShingle	Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS) Enfermedad de Parkinson Calidad de vida Epidemiología Parkinson disease Quality of life Epidemiology
title_short	Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS)
title_full	Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS)
title_fullStr	Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS)
title_full_unstemmed	Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS)
title_sort	Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS)
dc.creator.fl_str_mv	Hurtado González, Carlos Alberto Balestrino, Roberta Stocchi, Fabrizio Giada Radicati, Fabiana Chaudhuri, Ray Rodriguez Blazquez, Carmen Martinez Martin, Pablo The PDCS European Study Group
dc.contributor.author.none.fl_str_mv	Hurtado González, Carlos Alberto Balestrino, Roberta Stocchi, Fabrizio Giada Radicati, Fabiana Chaudhuri, Ray Rodriguez Blazquez, Carmen Martinez Martin, Pablo The PDCS European Study Group
dc.subject.spa.fl_str_mv	Enfermedad de Parkinson Calidad de vida Epidemiología
topic	Enfermedad de Parkinson Calidad de vida Epidemiología Parkinson disease Quality of life Epidemiology
dc.subject.other.spa.fl_str_mv	Parkinson disease Quality of life Epidemiology
description	El objetivo de este estudio fue determinar la presencia de manifestaciones de la enfermedad de Parkinson (EP), su distribución según subtipos motores y las relaciones con la calidad de vida relacionada con la salud (CdV) utilizando la Escala Compuesta de la Enfermedad de Parkinson patrocinada por la Asociación Europea de Enfermedad de Parkinson recientemente validada ( PDCS). La frecuencia de los síntomas se determinó mediante las puntuaciones de los elementos (presente si> 0). Utilizando el análisis ROC y el método de Youden, se proyectaron subtipos motores MDS-UPDRS en el PDCS para lograr una clasificación comparable basada en los puntajes del PDCS. Se utilizó el mismo método para estimar los niveles de gravedad a partir de otras medidas del estudio. La asociación entre PDCS y QoL (PDQ-39) se analizó mediante correlación y regresión lineal múltiple. La muestra estuvo formada por 776 pacientes en EP. Encontramos que la frecuencia de las manifestaciones de la EP con PDCS y MDS-UPDRS se superponían, siendo la diferencia promedio entre escalas solo del 5,5%. Utilizando el subtipo MDS-UPDRS, 215 pacientes (27,7%) fueron asignados como Temblor Dominante (TD), 60 (7,7%) Indeterminado y 501 (64,6%) Inestabilidad Postural y Dificultad de la Marcha (PIGD) en esta cohorte. Con esta clasificación como criterio, la relación basada en PDCS análoga proporcionó estos valores de corte: subtipo TD, ≥1.06; Indeterminado, <1,06 pero> 0,65; y PIGD, <0,65. La concordancia entre las dos escalas en esta clasificación fue sustancial (87,6%; kappa = 0,69). Los puntos de corte de la puntuación total del PDCS para la gravedad de la EP fueron: 23/24 para leve / moderada y 41/42 para moderada / grave. Se obtuvieron correlaciones de moderadas a altas (r = 0,35-0,80) entre PDCS y PDQ-39, y los cuatro dominios de PDCS mostraron una influencia independiente significativa en la calidad de vida. Las conclusiones son: (1) el PDCS evaluó la frecuencia de síntomas de la EP análoga a la MDS-UPDRS; (2) los subtipos motores y los niveles de gravedad se pueden determinar con el PDCS; (3) existe una asociación significativa entre las puntuaciones de PDCS y QoL.
publishDate	2019
dc.date.issued.none.fl_str_mv	2019-11
dc.date.accessioned.none.fl_str_mv	2021-03-19T20:29:27Z
dc.date.available.none.fl_str_mv	2021-03-19T20:29:27Z
dc.type.none.fl_str_mv	Artículos Científicos
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dc.identifier.issn.spa.fl_str_mv	2373-8057
dc.identifier.uri.spa.fl_str_mv	https://doi.org/10.1038/s41531-019-0097-1
dc.identifier.uri.none.fl_str_mv	https://hdl.handle.net/20.500.12494/33684
dc.identifier.bibliographicCitation.spa.fl_str_mv	Balestrino, R., Hurtado-Gonzalez, C.A., Stocchi, F. et al. Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS). npj Parkinsons Dis. 5, 26 (2019). https://doi.org/10.1038/s41531-019-0097-1
identifier_str_mv	2373-8057 Balestrino, R., Hurtado-Gonzalez, C.A., Stocchi, F. et al. Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS). npj Parkinsons Dis. 5, 26 (2019). https://doi.org/10.1038/s41531-019-0097-1
url	https://doi.org/10.1038/s41531-019-0097-1 https://hdl.handle.net/20.500.12494/33684
dc.relation.isversionof.spa.fl_str_mv	https://www.nature.com/articles/s41531-019-0097-1#citeas
dc.relation.ispartofjournal.spa.fl_str_mv	npj Parkinson's Disease
dc.relation.references.spa.fl_str_mv	Balestrino, R. & Martinez-Martin, P. Neuropsychiatric symptoms, behavioural disorders, and quality of life in Parkinson’s disease. J. Neurol. Sci. 373, 173–178 (2017). Barone, P. et al. The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Mov. Disord. 24, 1641–1649 (2009). Barone, P., Erro, R. & Picillo, M. Quality of life and nonmotor symptoms in Parkinson’s disease. Int. Rev. Neurobiol. 133, 499–516 (2017). Brown, C. A., Cheng, E. M., Hays, R. D., Vassar, S. D. & Vickrey, B. G. SF-36 includes less Parkinson disease (PD)-targeted content but is more responsive to change than two PD-targeted health-related quality of life measures. Qual. Life Res. 18, 1219–1237 (2009) Chaudhuri, K. R. et al. The burden of non-motor symptoms in Parkinson's disease using a self-completed non-motor questionnaire: a simple grading system. Parkinsonism Relat. Disord. 21, 287–291 (2015). Chaudhuri, K. R., Yates, L. & Martinez-Martin, P. The non-motor symptom complex Chaudhuri, K. R. et al. The nondeclaration of nonmotor symptoms of Parkinson's disease to health care professionals: an international study using the nonmotor symptoms questionnaire. Mov. Disord. 25, 704–709 (2010). Damiano, A. M. et al. Evaluation of a measurement strategy for Parkinson's disease: assessing patient health-related quality of life. Qual. Life Res. 9, 87–100 (2000). Fereshtehnejad, S. M. & Postuma, R. B. Subtypes of Parkinson’s disease: what do they tell us about disease progression? Curr. Neurol. Neurosci. Rep. 17, 34 (2017). Goetz, C. G. et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: Status and recommendations The Movement Disorder Society Task Force on rating scales for Parkinson’s disease. Mov. Disord. 19, 1020–1028 (2008). Goetz, C. G. et al. Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing results. Mov. Disord. 23, 2129–2170 (2008). Hays, R. D. et al. Effects of mode and order of administration on generic healthrelated quality of life scores. Value Health 12, 1035–1039 (2009). Hoehn, M. & Yahr, M. D. Parkinsonism: onset, progression and mortality. Neurology 17, 427–442 (1967). R. Balestrino et al. Published in partnership with the Parkinson’s Foundation npj Parkinson’s Disease (2019) Juniper en: Spilker, B. Quality of Life and Pharmacoeconomics in Clinical Trials. (Lippincott-Raven, Philadelphia, 1996). Kalia, L. V. & Lang, A. E. Parkinson’s disease. Lancet 386, 896–912 (2015). Lees, A. J., Hardy, J. & Revesz, T. Parkinson’s disease. Lancet 373, 2055–2066 (2009). Lozano, F. et al. Self-administered versus interview-based questionnaires among patients with intermittent claudication: Do they give different results? A crosssectional study. Sao Paulo Med J. 134, 63–69 (2016). Marras, C. & Chaudhuri, K. R. Nonmotor features of Parkinson’s disease subtypes. Mov. Disord. 31, 1095–1102 (2016). Martinez-Martin, P., Rodríguez-Blázquez, C., Forjaz, M. J. & de Pedro, J., SpanishAmerican Longitudinal PD Patient Study Group. The clinical impression of severity index for Parkinson’s disease: international validation study. Mov. Disord. 24, 211–217 (2009). Martinez-Martin P. et al. Extensive validation study of the Parkinson’s Disease Composite Scale. Eur. J. Neurol. https://doi.org/10.1111/ene.13976 (2019). Martinez-Martin, P. et al. Prevalence of nonmotor symptoms in Parkinson's disease in an international setting; Study using nonmotor symptoms questionnaire in 545 patients. Mov. Disord. 22, 1623–1629 (2007). Martinez-Martin, P. & Chaudhuri, K. R. Comprehensive grading of Parkinson’s disease using motor and non-motor assessments: addressing a key unmet need. Expert Rev. Neurother. 18, 41–50 (2018). Martinez-Martin, P. et al. Parkinson’s disease severity levels and MDS-Unified Parkinson’s Disease Rating Scale. Parkinsonism Relat. Disord. 21, 50–54 (2015). Martinez-Martin, P. An introduction to the concept of “quality of life in Parkinson's disease”. J. Neurol. 245(Suppl 1), S2–S6 (1998). Martinez-Martin, P. What is quality of life and how do we measure it? Relevance to Parkinson’s disease and movement disorders. Mov. Disord. 32, 382–392 (2017). Martinez-Martin, P. The importance of non-motor disturbances to quality of life in Parkinson’s disease. J. Neurol. Sci. 310, 12–16 (2011). Martínez-Martín, P. et al. Patients', doctors', and caregivers' assessment of disability using the UPDRS-ADL section: are these ratings interchangeable? Mov. Disord 18, 985–992 (2003). Martinez-Martin, P. Nonmotor symptoms and health-related quality of life in early Parkinson’s disease. Mov. Disord. 29, 166–168 (2014). Martinez-Martin, P., Rodriguez-Blazquez, C., Kurtis, M. M. & Chaudhuri, K. R., NMSS Validation Group. The impact of non-motor symptoms on health-related quality of life of patients with Parkinson's disease. Mov. Disord. 26, 399–406 (2011). of Parkinson's disease: a comprehensive a sessment is essential. Curr. Neurol. Neurosci. Rep. 5, 275–283 (2005). Peto, V., Jenkinson, C., Fitzpatrick, R. & Greenhall, R. The development and validation of a short measure of functioning and wellbeing for individuals with Parkinson's disease. Qual. Life Res. 4, 241–248 (1995). Postuma, R. B. et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov. Disord. 30, 1591–1601 (2015). Sauerbier, A., Jenner, P., Todorova, A. & Chaudhuri, K. R. Non motor subtypes and Parkinson's disease. Parkinsonism Relat. Disord. 22, S41–S46 (2016). Schapira, A. H. V., Chaudhuri, K. R. & Jenner, P. Non-motor features of Parkinson disease. Nat. Rev. Neurosci. 18, 435–450 (2017). Stebbins, G. T. et al. How to identify tremor dominant and postural instability/gait difficulty groups with the Movement Disorder Society Unified Parkinson’s Disease Rating Scale: comparison with the Unified Parkinson’s Disease Rating Scale. Mov. Disord. 28, 668–670 (2013). Stocchi, F. et al. The Parkinson’s Disease Composite Scale: results of the first validation study. Eur. J. Neurol. 25, 503–511 (2015). Titova, N., Padmakumar, C., Lewis, S. J. G. & Chaudhuri, K. R. Parkinson's: a syndrome rather than a disease? J. Neural Transm. 124, 907–914 (2017). van der Heeden, J. F. et al. Postural instability and gait are associated with severity and prognosis of Parkinson disease. Neurology 86, 2243–2250 (2016).
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spelling	Hurtado González, Carlos Alberto Balestrino, RobertaStocchi, FabrizioGiada Radicati, FabianaChaudhuri, RayRodriguez Blazquez, CarmenMartinez Martin, PabloThe PDCS European Study Group262021-03-19T20:29:27Z2021-03-19T20:29:27Z2019-112373-8057https://doi.org/10.1038/s41531-019-0097-1https://hdl.handle.net/20.500.12494/33684Balestrino, R., Hurtado-Gonzalez, C.A., Stocchi, F. et al. Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS). npj Parkinsons Dis. 5, 26 (2019). https://doi.org/10.1038/s41531-019-0097-1El objetivo de este estudio fue determinar la presencia de manifestaciones de la enfermedad de Parkinson (EP), su distribución según subtipos motores y las relaciones con la calidad de vida relacionada con la salud (CdV) utilizando la Escala Compuesta de la Enfermedad de Parkinson patrocinada por la Asociación Europea de Enfermedad de Parkinson recientemente validada ( PDCS). La frecuencia de los síntomas se determinó mediante las puntuaciones de los elementos (presente si> 0). Utilizando el análisis ROC y el método de Youden, se proyectaron subtipos motores MDS-UPDRS en el PDCS para lograr una clasificación comparable basada en los puntajes del PDCS. Se utilizó el mismo método para estimar los niveles de gravedad a partir de otras medidas del estudio. La asociación entre PDCS y QoL (PDQ-39) se analizó mediante correlación y regresión lineal múltiple. La muestra estuvo formada por 776 pacientes en EP. Encontramos que la frecuencia de las manifestaciones de la EP con PDCS y MDS-UPDRS se superponían, siendo la diferencia promedio entre escalas solo del 5,5%. Utilizando el subtipo MDS-UPDRS, 215 pacientes (27,7%) fueron asignados como Temblor Dominante (TD), 60 (7,7%) Indeterminado y 501 (64,6%) Inestabilidad Postural y Dificultad de la Marcha (PIGD) en esta cohorte. Con esta clasificación como criterio, la relación basada en PDCS análoga proporcionó estos valores de corte: subtipo TD, ≥1.06; Indeterminado, <1,06 pero> 0,65; y PIGD, <0,65. La concordancia entre las dos escalas en esta clasificación fue sustancial (87,6%; kappa = 0,69). Los puntos de corte de la puntuación total del PDCS para la gravedad de la EP fueron: 23/24 para leve / moderada y 41/42 para moderada / grave. Se obtuvieron correlaciones de moderadas a altas (r = 0,35-0,80) entre PDCS y PDQ-39, y los cuatro dominios de PDCS mostraron una influencia independiente significativa en la calidad de vida. Las conclusiones son: (1) el PDCS evaluó la frecuencia de síntomas de la EP análoga a la MDS-UPDRS; (2) los subtipos motores y los niveles de gravedad se pueden determinar con el PDCS; (3) existe una asociación significativa entre las puntuaciones de PDCS y QoL.This study was addressed to determine the presence of Parkinson disease (PD) manifestations, their distribution according to motor subtypes, and the relationships with health-related quality of life (QoL) using the recently validated European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS). Frequency of symptoms was determined by the scores of items (present if >0). Using ROC analysis and Youden method, MDS-UPDRS motor subtypes were projected on the PDCS to achieve a comparable classification based on the PDCS scores. The same method was used to estimate severity levels from other measures in the study. The association between the PDCS and QoL (PDQ-39) was analyzed by correlation and multiple linear regression. The sample consisted of 776 PD patients. We found that the frequency of PD manifestations with PDCS and MDS-UPDRS were overlapping, the average difference between scales being 5.5% only. Using the MDS-UPDRS subtyping, 215 patients (27.7%) were assigned as Tremor Dominant (TD), 60 (7.7%) Indeterminate, and 501 (64.6%) Postural Instability and Gait Difficulty (PIGD) in this cohort. With this classification as criterion, the analogous PDCS-based ratio provided these cut-off values: TD subtype, ≥1.06; Indeterminate, <1.06 but >0.65; and PIGD, <0.65. The agreement between the two scales on this classification was substantial (87.6%; kappa = 0.69). PDCS total score cut-offs for PD severity were: 23/24 for mild/moderate and 41/42 for moderate/severe. Moderate to high correlations (r = 0.35–0.80) between PDCS and PDQ-39 were obtained, and the four PDCS domains showed a significant independent influence on QoL. The conclusions are: (1) the PDCS assessed the frequency of PD symptoms analogous to the MDS-UPDRS; (2) motor subtypes and severity levels can be determined with the PDCS; (3) a significant association between PDCS and QoL scores exists.carlos.hurtadog@campusucc.edu.co7 p.Universidad Cooperativa de Colombia, Facultad de Ciencias Sociales, Psicología, CaliPsicologíaCalihttps://www.nature.com/articles/s41531-019-0097-1#citeasnpj Parkinson's DiseaseBalestrino, R. & Martinez-Martin, P. Neuropsychiatric symptoms, behavioural disorders, and quality of life in Parkinson’s disease. J. Neurol. Sci. 373, 173–178 (2017).Barone, P. et al. The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Mov. Disord. 24, 1641–1649 (2009).Barone, P., Erro, R. & Picillo, M. Quality of life and nonmotor symptoms in Parkinson’s disease. Int. Rev. Neurobiol. 133, 499–516 (2017).Brown, C. A., Cheng, E. M., Hays, R. D., Vassar, S. D. & Vickrey, B. G. SF-36 includes less Parkinson disease (PD)-targeted content but is more responsive to change than two PD-targeted health-related quality of life measures. Qual. Life Res. 18, 1219–1237 (2009)Chaudhuri, K. R. et al. The burden of non-motor symptoms in Parkinson's disease using a self-completed non-motor questionnaire: a simple grading system. Parkinsonism Relat. Disord. 21, 287–291 (2015).Chaudhuri, K. R., Yates, L. & Martinez-Martin, P. The non-motor symptom complexChaudhuri, K. R. et al. The nondeclaration of nonmotor symptoms of Parkinson's disease to health care professionals: an international study using the nonmotor symptoms questionnaire. Mov. Disord. 25, 704–709 (2010).Damiano, A. M. et al. Evaluation of a measurement strategy for Parkinson's disease: assessing patient health-related quality of life. Qual. Life Res. 9, 87–100 (2000).Fereshtehnejad, S. M. & Postuma, R. B. Subtypes of Parkinson’s disease: what do they tell us about disease progression? Curr. Neurol. Neurosci. Rep. 17, 34 (2017).Goetz, C. G. et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: Status and recommendations The Movement Disorder Society Task Force on rating scales for Parkinson’s disease. Mov. Disord. 19, 1020–1028 (2008).Goetz, C. G. et al. Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing results. Mov. Disord. 23, 2129–2170 (2008).Hays, R. D. et al. Effects of mode and order of administration on generic healthrelated quality of life scores. Value Health 12, 1035–1039 (2009).Hoehn, M. & Yahr, M. D. Parkinsonism: onset, progression and mortality. Neurology 17, 427–442 (1967). R. Balestrino et al. Published in partnership with the Parkinson’s Foundation npj Parkinson’s Disease (2019)Juniper en: Spilker, B. Quality of Life and Pharmacoeconomics in Clinical Trials. (Lippincott-Raven, Philadelphia, 1996).Kalia, L. V. & Lang, A. E. Parkinson’s disease. Lancet 386, 896–912 (2015).Lees, A. J., Hardy, J. & Revesz, T. Parkinson’s disease. Lancet 373, 2055–2066 (2009).Lozano, F. et al. Self-administered versus interview-based questionnaires among patients with intermittent claudication: Do they give different results? A crosssectional study. Sao Paulo Med J. 134, 63–69 (2016).Marras, C. & Chaudhuri, K. R. Nonmotor features of Parkinson’s disease subtypes. Mov. Disord. 31, 1095–1102 (2016).Martinez-Martin, P., Rodríguez-Blázquez, C., Forjaz, M. J. & de Pedro, J., SpanishAmerican Longitudinal PD Patient Study Group. The clinical impression of severity index for Parkinson’s disease: international validation study. Mov. Disord. 24, 211–217 (2009).Martinez-Martin P. et al. Extensive validation study of the Parkinson’s Disease Composite Scale. Eur. J. Neurol. https://doi.org/10.1111/ene.13976 (2019).Martinez-Martin, P. et al. Prevalence of nonmotor symptoms in Parkinson's disease in an international setting; Study using nonmotor symptoms questionnaire in 545 patients. Mov. Disord. 22, 1623–1629 (2007).Martinez-Martin, P. & Chaudhuri, K. R. Comprehensive grading of Parkinson’s disease using motor and non-motor assessments: addressing a key unmet need. Expert Rev. Neurother. 18, 41–50 (2018).Martinez-Martin, P. et al. Parkinson’s disease severity levels and MDS-Unified Parkinson’s Disease Rating Scale. Parkinsonism Relat. Disord. 21, 50–54 (2015).Martinez-Martin, P. An introduction to the concept of “quality of life in Parkinson's disease”. J. Neurol. 245(Suppl 1), S2–S6 (1998).Martinez-Martin, P. What is quality of life and how do we measure it? Relevance to Parkinson’s disease and movement disorders. Mov. Disord. 32, 382–392 (2017).Martinez-Martin, P. The importance of non-motor disturbances to quality of life in Parkinson’s disease. J. Neurol. Sci. 310, 12–16 (2011).Martínez-Martín, P. et al. Patients', doctors', and caregivers' assessment of disability using the UPDRS-ADL section: are these ratings interchangeable? Mov. Disord 18, 985–992 (2003).Martinez-Martin, P. Nonmotor symptoms and health-related quality of life in early Parkinson’s disease. Mov. Disord. 29, 166–168 (2014).Martinez-Martin, P., Rodriguez-Blazquez, C., Kurtis, M. M. & Chaudhuri, K. R., NMSS Validation Group. The impact of non-motor symptoms on health-related quality of life of patients with Parkinson's disease. Mov. Disord. 26, 399–406 (2011). of Parkinson's disease: a comprehensive a sessment is essential. Curr. Neurol. Neurosci. Rep. 5, 275–283 (2005).Peto, V., Jenkinson, C., Fitzpatrick, R. & Greenhall, R. The development and validation of a short measure of functioning and wellbeing for individuals with Parkinson's disease. Qual. Life Res. 4, 241–248 (1995).Postuma, R. B. et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov. Disord. 30, 1591–1601 (2015).Sauerbier, A., Jenner, P., Todorova, A. & Chaudhuri, K. R. Non motor subtypes and Parkinson's disease. Parkinsonism Relat. Disord. 22, S41–S46 (2016).Schapira, A. H. V., Chaudhuri, K. R. & Jenner, P. Non-motor features of Parkinson disease. Nat. Rev. Neurosci. 18, 435–450 (2017).Stebbins, G. T. et al. How to identify tremor dominant and postural instability/gait difficulty groups with the Movement Disorder Society Unified Parkinson’s Disease Rating Scale: comparison with the Unified Parkinson’s Disease Rating Scale. Mov. Disord. 28, 668–670 (2013).Stocchi, F. et al. The Parkinson’s Disease Composite Scale: results of the first validation study. Eur. J. Neurol. 25, 503–511 (2015).Titova, N., Padmakumar, C., Lewis, S. J. G. & Chaudhuri, K. R. Parkinson's: a syndrome rather than a disease? J. Neural Transm. 124, 907–914 (2017).van der Heeden, J. F. et al. Postural instability and gait are associated with severity and prognosis of Parkinson disease. 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Applications of the European Parkinson’s Disease Association sponsored Parkinson’s Disease Composite Scale (PDCS)

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