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Lateralization of Motor Signs Affects Symptom Progression in Parkinson Disease

Background: Asymmetry of motor signs is a cardinal feature of Parkinson disease which may impact phenotypic expression. Objective: To investigate the relationship between lateralization of motor signs and symptom progression and severity during longitudinal observation for up to 4 years in a natural...

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Autores principales: Elkurd, Mazen, Wang, Jijia, Dewey, Richard B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353110/
https://www.ncbi.nlm.nih.gov/pubmed/34385975
http://dx.doi.org/10.3389/fneur.2021.711045
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author Elkurd, Mazen
Wang, Jijia
Dewey, Richard B.
author_facet Elkurd, Mazen
Wang, Jijia
Dewey, Richard B.
author_sort Elkurd, Mazen
collection PubMed
description Background: Asymmetry of motor signs is a cardinal feature of Parkinson disease which may impact phenotypic expression. Objective: To investigate the relationship between lateralization of motor signs and symptom progression and severity during longitudinal observation for up to 4 years in a naturalistic study. Methods: We analyzed data prospectively collected during the NINDS Parkinson Disease Biomarker Project (PDBP). We defined the Movement Disorder Society Revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS) part II as the primary measure of symptom progression. Left side predominant subjects were those whose lateralized motor scores on the MDS-UPDRS part III were ≥2 points higher on the left side than on the right side of the body. Multiple regression models (controlled for age, gender, education years, ethnicity, levodopa equivalent daily dose (LEDD) at baseline, and years with PD) were used to estimate the rate of symptom progression comparing left predominant (LPD) with non-left predominant (NLPD) subjects. A sensitivity analysis was performed using the same multiple regression models in the subgroups of low (0–26) or high (>27) MDS-UPDRS II score at baseline to determine if PD severity influenced the results. Results: We included 390 participants, 177 LPD and 213 NLPD. We found that MDS-UPDRS part II progression from baseline to 48 months was faster in LPD compared to NLPD (0.6 points per year faster in LPD, p = 0.05). Additionally, the LPD group was statistically significantly worse at baseline and at 48 months in several subparts of the MDS-UPDRS and the Parkinson's Disease Questionnaire-39 (PDQ-39) mobility score. Significantly slower progression (difference of −0.8, p = 0.01) and lower score at 48 months (difference of −3.8, p = 0.003) was seen for NLPD vs. LPD in the group with lower baseline MDS-UPDRS part II score. Conclusion: Left side lateralization was associated with faster symptom progression and worse outcomes in multiple clinical domains in our cohort. Clinicians should consider using motor predominance in their counseling regarding prognosis.
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spelling pubmed-83531102021-08-11 Lateralization of Motor Signs Affects Symptom Progression in Parkinson Disease Elkurd, Mazen Wang, Jijia Dewey, Richard B. Front Neurol Neurology Background: Asymmetry of motor signs is a cardinal feature of Parkinson disease which may impact phenotypic expression. Objective: To investigate the relationship between lateralization of motor signs and symptom progression and severity during longitudinal observation for up to 4 years in a naturalistic study. Methods: We analyzed data prospectively collected during the NINDS Parkinson Disease Biomarker Project (PDBP). We defined the Movement Disorder Society Revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS) part II as the primary measure of symptom progression. Left side predominant subjects were those whose lateralized motor scores on the MDS-UPDRS part III were ≥2 points higher on the left side than on the right side of the body. Multiple regression models (controlled for age, gender, education years, ethnicity, levodopa equivalent daily dose (LEDD) at baseline, and years with PD) were used to estimate the rate of symptom progression comparing left predominant (LPD) with non-left predominant (NLPD) subjects. A sensitivity analysis was performed using the same multiple regression models in the subgroups of low (0–26) or high (>27) MDS-UPDRS II score at baseline to determine if PD severity influenced the results. Results: We included 390 participants, 177 LPD and 213 NLPD. We found that MDS-UPDRS part II progression from baseline to 48 months was faster in LPD compared to NLPD (0.6 points per year faster in LPD, p = 0.05). Additionally, the LPD group was statistically significantly worse at baseline and at 48 months in several subparts of the MDS-UPDRS and the Parkinson's Disease Questionnaire-39 (PDQ-39) mobility score. Significantly slower progression (difference of −0.8, p = 0.01) and lower score at 48 months (difference of −3.8, p = 0.003) was seen for NLPD vs. LPD in the group with lower baseline MDS-UPDRS part II score. Conclusion: Left side lateralization was associated with faster symptom progression and worse outcomes in multiple clinical domains in our cohort. Clinicians should consider using motor predominance in their counseling regarding prognosis. Frontiers Media S.A. 2021-07-27 /pmc/articles/PMC8353110/ /pubmed/34385975 http://dx.doi.org/10.3389/fneur.2021.711045 Text en Copyright © 2021 Elkurd, Wang and Dewey. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Elkurd, Mazen
Wang, Jijia
Dewey, Richard B.
Lateralization of Motor Signs Affects Symptom Progression in Parkinson Disease
title Lateralization of Motor Signs Affects Symptom Progression in Parkinson Disease
title_full Lateralization of Motor Signs Affects Symptom Progression in Parkinson Disease
title_fullStr Lateralization of Motor Signs Affects Symptom Progression in Parkinson Disease
title_full_unstemmed Lateralization of Motor Signs Affects Symptom Progression in Parkinson Disease
title_short Lateralization of Motor Signs Affects Symptom Progression in Parkinson Disease
title_sort lateralization of motor signs affects symptom progression in parkinson disease
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353110/
https://www.ncbi.nlm.nih.gov/pubmed/34385975
http://dx.doi.org/10.3389/fneur.2021.711045
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