Alastair Noyce, PhD, MSc, BMedSci
Results from an analysis of three separate longitudinal studies show that individuals stratified as high risk using the PREDICT-PD algorithm are less likely to develop new-onset subthreshold parkinsonism (SP) over time. ) and were shown to be twice as likely to develop SP per follow-up. Unit change in risk score. Overall, a low-intensity and cost-effective approach has the potential to estimate the occurrence of motor disturbances in the future.1
Of the 181 participants identified at baseline, 2 died and 15 declined participation for personal and medical reasons. After excluding those who could not be contacted (n = 32), we directly surveyed 132 participants. This analysis featured a sample of participants from his PREDICT-PD pilot cohort observed from 2012 to 2018. These patients were over 60 years old, had no known neurological disease, and lived in the UK.
Led by Alastair Noyce, PhD, MSc, BMedSci, Professor of Neurology and Neuroepidemiology at Queen Mary University of London, participants in PREDICT-PD will follow a questionnaire based on evidence from a systematic review. I took an online assessment that included a validated keyboard tapping test. , the smell test was also completed. Using the PREDICT-PD algorithm, patients were stratified as high risk (HR) or low risk (LR) based on rank estimates above or below the 15th percentile, respectively. HR also completed her MDS Unified Parkinson’s Disease Rating Scale (UPDRS)-III, a follow-up assessment that included a timed handwriting test, and the Montreal Cognitive Assessment (MoCA) in 2018.
A priori age-related PD risks were calculated and adjusted according to the presence or absence of risk determinants. Determinants of risk include gender, coffee use, current/former/non-smoker, alcohol intake, first degree relationship with PD, and constipation. , erectile dysfunction, depression/anxiety, exposure to pesticides, diabetes, head trauma, use of nonsteroidal anti-inflammatory drugs, calcium channel blockers, and beta blockers.
Given the low incidence of PD, the study authors used three surrogate markers at follow-up testing as binary outcomes in the predictive model. These include the onset of SP based on the MDS study criteria for prodromal PD, decreased motor function as indicated by a change of at least 5 points on the MDS-UPDRS-III compared between the four groups, and includes abnormalities in a single motor domain. UPDRS-III. The analysis on PREDICT-PD participants was replicated in two of his separate studies: the Bruneck study and the Parkinson Progressive Markers Initiative (PPMI) study.
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The final analysis included 128 participants (HR: n = 33, LR: n = 95), with the HR group being older (P <.001), more likely to be male (P = .001). Both groups had similar rates of vascular risk factors, including type 2 diabetes, high blood pressure, and high cholesterol. In PREDICT-PD, a higher proportion of new cases of SP incidents was observed in the HR group, with a 1.7-fold increased odds per unit change in risk score (OR, 1.70; 95% CI, 0.99-2.94; 95% CI, 0.99-2.94; coefficient, 0.53; intercept, 0.33; P = .053).
Using the same algorithm, an association between risk score and incident SP was observed in Bruneck (OR, 2.28; 95% CI, 1.55-3.34; P <.001) and PPMI study (OR, 1.90; 95% CI, 1.19-3.03; P =.007). Combining all three cohorts, the meta-analysis showed an OR of 2.01 (95% CI, 1.55-2.61; P <.001).
Regarding reduced exercise capacity, the median MDS-UPDRS-III scores at baseline for the HR and LR groups were 5 (IQR, 2-6) and 2 (IQR, 0-4), respectively. After 6 years of follow-up, the HR group maintained higher motor scores than the LR group (HR: median, 7 [IQR, 3-9] LR: median, 3 [IQR, 1-5]; P = .001), over time, 30.3% (10 of 33) of the HR group showed a decline in motor function, defined as a change in motor score of at least 5 points; 12.6% (12/95) showed decreased motor skills. LR group (P = .031). There was nominal evidence to suggest that the HR group was three times more likely to experience decreased exercise capacity than the LR group (OR, 3.01; 95% CI, 1.15-7.84; coefficient, 1.10; intercept, – 1.28, P = .024).
The algorithm also appears to estimate the occurrence of bradykinesia. Among risk groups, bradykinesia was found in 57.6% of individuals with HR and 28.4% of individuals with LR. Similarly, those classified as HR were more likely to develop new-onset action tremor (75.7% vs. 46.3%; P = .004). Using a logistic regression model, the researchers observed nominal evidence that HR personnel were more than twice as likely to develop bradykinesia over time (OR, 2.67, 95% CI , 1.07-6.62, coefficient, 0.98, intercept, -1.67, P = .035). The association between incident bradykinesia and PD HR was stronger after adjusting for age and sex (adjusted OR, 5.88; 95% CI, 1.83-18.92; coefficient, 1.78; intercept, 7.49; P = .011).
