Parkinson disease clinical subtypes: key features & clinical milestones.

Publisher: Wiley Periodicals, Inc on behalf of American Neurological Association Country of Publication: United States NLM ID: 101623278 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2328-9503 (Electronic) Linking ISSN: 23289503 NLM ISO Abbreviation: Ann Clin Transl Neurol Subsets: MEDLINE

Original Publication: [Hoboken, NJ] : Wiley Periodicals, Inc on behalf of American Neurological Association, [2014]-

Apathy/*physiology ; Cognitive Dysfunction/*physiopathology ; Dementia/*physiopathology ; Depression/*physiopathology ; Executive Function/*physiology ; Parkinson Disease/*classification ; Parkinson Disease/*physiopathology; Aged ; Cognitive Dysfunction/etiology ; Deep Brain Stimulation ; Dementia/etiology ; Depression/etiology ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Parkinson Disease/complications ; Parkinson Disease/mortality

Objectives: Based on multi-domain classification of Parkinson disease (PD) subtypes, we sought to determine the key features that best differentiate subtypes and the utility of PD subtypes to predict clinical milestones.
Methods: Prospective cohort of 162 PD participants with ongoing, longitudinal follow-up. Latent class analysis (LCA) delineated subtypes based on score patterns across baseline motor, cognitive, and psychiatric measures. Discriminant analyses identified key features that distinguish subtypes at baseline. Cox regression models tested PD subtype differences in longitudinal conversion to clinical milestones, including deep brain stimulation (DBS), dementia, and mortality.
Results: LCA identified distinct subtypes: "motor only" (N = 63) characterized by primary motor deficits; "psychiatric & motor" (N = 17) characterized by prominent psychiatric symptoms and moderate motor deficits; "cognitive & motor" (N = 82) characterized by impaired cognition and moderate motor deficits. Depression, executive function, and apathy best discriminated subtypes. Since enrollment, 22 had DBS, 48 developed dementia, and 46 have died. Although there were no subtype differences in rate of DBS, dementia occurred at a higher rate in the "cognitive & motor" subtype. Surprisingly, mortality risk was similarly elevated for both "cognitive & motor" and "psychiatric & motor" subtypes compared to the "motor only" subtype (relative risk = 3.15, 2.60).
Interpretation: Psychiatric and cognitive features, rather than motor deficits, distinguish clinical PD subtypes and predict greater risk of subsequent dementia and mortality. These results emphasize the value of multi-domain assessments to better characterize clinical variability in PD. Further, differences in dementia and mortality rates demonstrate the prognostic utility of PD subtypes.
(© 2020 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

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NS41509 United States NS NINDS NIH HHS; UL1 RR024992 United States RR NCRR NIH HHS; R01 NS075321 United States NS NINDS NIH HHS; R01 NS041509 United States NS NINDS NIH HHS; R01 NS058714 United States NS NINDS NIH HHS; UL1 TR002345 United States TR NCATS NIH HHS; RF1 NS075321 United States NS NINDS NIH HHS; NS075321 United States NS NINDS NIH HHS; K08 NS048924 United States NS NINDS NIH HHS; NS058714 United States NS NINDS NIH HHS; NS097437 United States NS NINDS NIH HHS; NS48924 United States NS NINDS NIH HHS; P30 NS048056 United States NS NINDS NIH HHS; R01 NS097437 United States NS NINDS NIH HHS

Date Created: 20200701 Date Completed: 20211015 Latest Revision: 20240428

20240428

PMC7448190

10.1002/acn3.51102

32602253