The Dashboard Vitals of Parkinson's: Not to Be Missed Yet an Unmet Need

Validation of the International Parkinson and Movement Disorder Society Non-Motor Symptoms Questionnaire (MDS-NMS-Q)

BACKGROUND

The Movement Disorder Society Non-Motor Rating Scale (MDS-NMS) assesses severity and frequency of non-motor symptoms (NMS) in Parkinson's disease (PD) and is rater-administered. The MDS-NMS Questionnaire (MDS-NMS-Q), developed as a briefer (i.e., assessing symptom severity only), self-completed version of the MDS-NMS, is also a 13-domain, 52-symptom instrument with a separate non-motor fluctuations (NMFs) section.

OBJECTIVE

The goal was to validate the MDS-NMS-Q versus the MDS-NMS.

METHODS

A cross-sectional, multi-site, international study was conducted with idiopathic PD patients. After completing the self-administered MDS-NMS-Q unsupervised, patients were assessed with the rater-administered MDS-NMS.

RESULTS

The cohort consisted of 199 PD patients (mean age [±standard deviation (SD)] = 67.19 [±9.95] years; mean age at PD diagnosis [±SD] = 59.27 [±9.54] years); median Hoehn and Yahr stage = 2. Data quality was satisfactory for all 13 MDS-NMS-Q domains. There were no floor or ceiling effects for the total score; individual domains had no appreciable ceiling effects, but variable floor effects (5.0%-71.4%). Internal consistency for most domains was satisfactory, except for the impulse control domain (Cronbach's α ≥0.75 for 10/13 domains). Correlation and concordance between MDS-NMS-Q and MDS-NMS total scores were high (Spearman rank correlation coefficient = 0.86; Kendall's coefficient of concordance = 0.93).

CONCLUSIONS

The MDS-NMS-Q has a strong association and concordance with the MDS-NMS at the total score and domain level. This indicates that the MDS-NMS-Q, allowing self-completion and focusing only on symptom severity, is an acceptable alternative to rater administration assessing both severity and frequency. © 2025 International Parkinson and Movement Disorder Society.

Test, track, treat using wearable sensors for management of Parkinson's disease: 12‑month prospective observational United Arab Emirates study using Parkinson's Kinetograph (EmPark-PKG Study)

Parkinson's disease (PD) is a progressive neurodegenerative disorder marked by both motor and non-motor symptoms that necessitate ongoing clinical evaluation and medication adjustments. Home-based wearable sensor monitoring offers a detailed and continuous record of patient symptoms, potentially enhancing disease management. The EmPark-PKG study aims to evaluate the effectiveness of the Parkinson's KinetoGraph (PKG), a wearable sensor device, in monitoring and tracking the progression of motor symptoms over 12 months in Emirati and non-Emirati PD patients. Fifty PD patients (32% Emirati, 68% non-Emirati) were assessed at baseline and a 12-month follow-up. Clinical evaluations included levodopa equivalent daily dosage (LEDD) and motor and non-motor assessments. Concurrently, the PKG provided metrics such as bradykinesia score (BKS) and dyskinesia score (DKS). Statistical analyses were conducted to determine changes from baseline to six months, differences between Emirati and non-Emirati groups, and correlations between PKG metrics and clinical assessments. Significant reductions in LEDD and improvements in both motor and non-motor scores were observed from baseline to six months (p < 0.05). PKG-guided medication adjustments were associated with enhanced motor and non-motor outcomes (p < 0.05). Specifically, non-Emirati patients exhibited a significant reduction in LEDD (Z = - 2.010, p = 0.044), whereas Emirati patients did not (Z = - 0.468, p = 0.640). Both groups showed significant improvements in motor scale scores and motor complication scores. Spearman correlation analysis revealed strong relationships between PKG metrics and subjective clinical assessments (p < 0.001). The EmPark-PKG study demonstrates the potential benefits of remote PKG monitoring for personalised motor symptom management in PD. PKG supports a stepped care paradigm by enabling bespoke medication titration based on objective data, facilitating tailored and effective patient care.

Pharmacological and non-pharmacological management of sleep disturbances in Parkinson's disease: if when and how

INTRODUCTION

Sleep dysfunction occurs in various forms and is a bothersome and intrusive non-motor symptom of Parkinson's disease (PD). Frequently undiagnosed, their poor management can have a great impact on the quality of life of PD patients and their caregivers.

AREAS COVERED

This article covers the safety and efficacy of pharmacological strategies for the management of the most frequent sleep disturbances in Parkinson's disease. Non-pharmacological aspects are also discussed, but these are not the main focus. Literature searches using electronic databases (Medline, Cochrane Library) and systematic checking of references from review articles/other reports were performed.

EXPERT OPINION

Melatonin and clonazepam are the most commonly used therapies for the management of REM sleep behavior disorder (RBD). The most used pharmacological wake-promoting agents in the treatment of excessive daytime sleepiness (EDS) are modafinil and caffeine. Poor nocturnal sleep quality is usually linked to EDS, thus proper sleep hygiene is recommended. As nocturnal motor symptoms are commonly associated with sleep fragmentation and early morning off, optimization of dopaminergic treatment during nighttime is highly recommended for the proper management of insomnia. Further interventions include eszopiclone and melatonin for the management of insomnia. Therapeutic options for restless legs syndrome (RLS) include calcium channel alpha-2-delta ligands and low-dose dopamine agonists (DA). Further confirmatory evidence is needed before the general recommendation of these treatments.

Long-term safety, tolerability and efficacy of apomorphine sublingual film in patients with Parkinson's disease complicated by OFF episodes: a phase 3, open-label study

BACKGROUND

Apomorphine sublingual film (SL-APO) is an on-demand treatment for OFF episodes in patients with Parkinson's disease (PD).

OBJECTIVE

To assess the long-term (≥ 3 years) safety/tolerability and efficacy of SL-APO.

METHODS

Study CTH-301 ( http://www.

CLINICALTRIALS

gov NCT02542696; registered 2015-09-03) was a phase 3, multicentre, open-label study of SL-APO in PD patients with motor fluctuations, comprised of a dose-titration and long-term safety phase. All participants received SL-APO. The primary endpoint was safety/tolerability (treatment-emergent adverse events [TEAEs]) during the long-term safety phase. Efficacy assessments included the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III (motor examination), assessed at weeks 24, 36 and 48 during the first year of the long-term safety phase.

RESULTS

496 patients were included and 120 (24.2%) completed the long-term safety phase. Mean duration of SL-APO exposure was 294.3 days. TEAEs related to study drug were experienced by 65.3% of patients (most common: nausea [6.0%], stomatitis [1.8%], lip swelling [1.8%], dizziness [1.6%], oral mucosal erythema [1.6%], mouth ulceration [1.6%]). TEAEs leading to study drug withdrawal were experienced by 34.0% of patients (most common: nausea [5.4%], lip swelling [4.5%], mouth ulceration [2.6%], stomatitis [2.3%]). A clinically meaningful reduction in MDS-UPDRS part III score was observed as soon as 15 min following administration of SL-APO, with peak effects observed approximately 30 min post-dose and sustained up to 90 min post-dose; results were consistent over 48 weeks.

CONCLUSIONS

SL-APO was generally well tolerated and efficacious over the long term as an on-demand treatment for OFF episodes in patients with PD.

Addressing Comorbidities in People with Parkinson's Disease: Considerations From An Expert Panel

In the UK, guidance exists to aid clinicians and patients deciding when treatment for Parkinson's disease (PD) should be initiated and which therapies to consider. National Institute for Health and Care Excellence (NICE) guidance recommends that before starting PD treatment clinicians should discuss the following: the patient's individual clinical circumstances; lifestyle; preferences; needs and goals; as well as the potential benefits and harms of the different drug classes. Individualization of medicines and management in PD significantly improves patients' outcomes and quality of life. This article aims to provide simple and practical guidance to help clinicians address common, but often overlooked, co-morbidities. A multi-disciplinary group of PD experts discussed areas where clinical care can be improved by addressing commonly found co-morbidities in people with Parkinson's (PwP) based on clinical experience and existing literature, in a roundtable meeting organized and funded by Bial Pharma UK Ltd. The experts identified four core areas (bone health, cardiovascular risk, anticholinergic burden, and sleep quality) that, if further standardized may improve treatment outcomes for PwP patients. Focusing on anticholinergic burden, cardiac risk, sleep, and bone health could offer a significant contribution to personalizing regimes for PwP and improving overall patient outcomes. Within this opinion-based paper, the experts offer a list of guiding factors to help practitioners in the management of PwP.

The Park Sleep subtype in Parkinson's disease: from concept to clinic

INTRODUCTION

The heterogeneity of Parkinson's disease (PD) is evident from descriptions of non-motor (NMS) subtypes and Park Sleep, originally identified by Sauerbier et al. 2016, is one such clinical subtype associated with the predominant clinical presentation of sleep dysfunctions including excessive daytime sleepiness (EDS), along with insomnia.

AREAS COVERED

A literature search was conducted using the PubMed, Medline, Embase, and Web of Science databases, accessed between 1 February 2023 and 28 March 2023. In this review, we describe the clinical subtype of Park Sleep and related 'tests' ranging from polysomnography to investigational neuromelanin MRI brain scans and some tissue-based biological markers.

EXPERT OPINION

Cholinergic, noradrenergic, and serotonergic systems are dominantly affected in PD. Park Sleep subtype is hypothesized to be associated primarily with serotonergic deficit, clinically manifesting as somnolence and narcoleptic events (sleep attacks), with or without rapid eye movement behavior disorder (RBD). In clinic, Park Sleep recognition may drive lifestyle changes (e.g. driving) along with therapy adjustments as Park Sleep patients may be sensitive to dopamine D3 active agonists, such as ropinirole and pramipexole. Specific dashboard scores based personalized management options need to be implemented and include pharmacological, non-pharmacological, and lifestyle linked advice.

Dry eye in Parkinson's disease: a narrative review

In Parkinson's disease (PD) patients, a wide range of ocular and visual disorders are present. Tear film instability, inflammation and dysfunction of the ocular surface, and the presence of symptoms of visual disturbance characterize dry eye, a multifactorial disease of the ocular surface. Based on a literature search, we discuss the frequency, pathogenesis, and influence on the quality of life of patients with dry eye in Parkinson's disease. Furthermore, we review the available means of diagnosis and management of dry eye. An improvement in awareness and recognition of dry eye is needed to provide suitable, personalized therapeutic options for PD patients, aiming to improve their quality of life, independence, and safety.

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

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.

The noradrenergic subtype of Parkinson disease: from animal models to clinical practice

Many advances in understanding the pathophysiology of Parkinson disease (PD) have been based on research addressing its motor symptoms and phenotypes. Various data-driven clinical phenotyping studies supported by neuropathological and in vivo neuroimaging data suggest the existence of distinct non-motor endophenotypes of PD even at diagnosis, a concept further strengthened by the predominantly non-motor spectrum of symptoms in prodromal PD. Preclinical and clinical studies support early dysfunction of noradrenergic transmission in both the CNS and peripheral nervous system circuits in patients with PD that results in a specific cluster of non-motor symptoms, including rapid eye movement sleep behaviour disorder, pain, anxiety and dysautonomia (particularly orthostatic hypotension and urinary dysfunction). Cluster analyses of large independent cohorts of patients with PD and phenotype-focused studies have confirmed the existence of a noradrenergic subtype of PD, which had been previously postulated but not fully characterized. This Review discusses the translational work that unravelled the clinical and neuropathological processes underpinning the noradrenergic PD subtype. Although some overlap with other PD subtypes is inevitable as the disease progresses, recognition of noradrenergic PD as a distinct early disease subtype represents an important advance towards the delivery of personalized medicine for patients with PD.