Absolutely delighted to see this one in print... this is the culmination of a huge amount of work... ~20,000 miles driven by me to see participants in the PREDICT-PD study and hundreds of hours spent watching videos by Andrew Lees and Anette Schrag. We give an unbiased estimate of the prevalence of mild parkinsonian signs in higher risk PREDICT-PD participants and show that the basic risk algorithm predicts motor dysfunction. This paper somewhat rejects the notion of 'premotor' PD and suggests the motor dysfunction occurs in the pre-diagnostic phase and can be ascertained remotely via video...
J Neurol Neurosurg Psychiatry. 2016 Dec 16. pii: jnnp-2016-314524. doi: 10.1136/jnnp-2016-314524. [Epub ahead of print]
Noyce AJ, Schrag A, Masters JM, Bestwick JP, Giovannoni G, Lees AJ.
http://jnnp.bmj.com/content/early/2016/12/16/jnnp-2016-314524.long
OBJECTIVE:
The PREDICT-PD study aims to identify increased risk of Parkinson''s disease (PD) using online assessments of previously identified risk and early features of PD and an evidence-based scoring algorithm. We sought to determine whether higher risk participants (defined as those above the 15th centile of risk estimates) were more likely to have mild parkinsonian signs compared with lower risk participants.
METHODS:
Video recordings of neurological examinations, including the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III, of 208 individuals who had previously completed an online risk assessment were scored blindly and independently by two movement-disorders experts. Higher risk and lower risk subjects were compared for MDS-UPDRS part III score (and derivations of this) to identify subclinical parkinsonism, and association of risk estimates with MDS-UPDRS III scores assessed.
RESULTS:
Higher risk subjects had significantly higher median UPDRS part III scores (3, IQR 1-5.5) than lower risk subjects (1, IQR 0-3.0; p<0.001), and there was a significantly greater proportion of individuals classified as having subclinical parkinsonism. 18% of the higher risk subjects and 6% of the lower risk subjects exceeded the most stringent published cut-off for subtle parkinsonism of three definitions examined (p=0.027). Linear regression analysis demonstrated a continuous relationship of log-transformed risk estimates with UPDRS part III scores (increase in MDS-UPDRS per doubling of odds 0.52, 95% CI 0.31 to 0.72; p<0.001), which remained after adjustment for multiple vascular risk factors and scores on the Montreal Cognitive Assessment (0.58, 95% CI 0.30 to 0.87; p<0.001).
CONCLUSIONS:
The PREDICT-PD algorithm identifies a population with an increased rate of motor disturbances.
I wonder if this assessment could be complemented by invoking the services of the lady who has shown she can 'smell' Parkinson's. If she were to 'test' the at risk people it might firm up a diagnosis early enough for gut bacteriome modification to stop the development of PD at all.
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