title: Segmental progression of early untreated Parkinson's disease: a novel approach to clinical rating.
abstract: OBJECTIVE
  To assess the ability of potentially neuroprotective compounds to slow the progression of Parkinson's disease (PD), sensitive rating scales are needed to detect clinically meaningful effects. The topographical progression of motor signs in early untreated PD was evaluated to complement current clinical ratings and enhance the sensitivity to detect disease progression.
  
  
  METHODS
  12 patients referred for diagnostic evaluation of untreated de novo PD underwent detailed clinical assessment of motor parkinsonian signs at baseline and after 6 and 12 months of follow-up using the Unified Parkinson's Disease Rating Scale, motor part (UPDRS-III), and a newly developed approach of detailed segmental rating taking into account the localisation of motor signs in all of the major joints and muscle groups in the body. The progression of PD, as measured with the UPDRS-III, was compared with the segmental ratings.
  
  
  RESULTS
  UPDRS-III scores and segmental ratings for rigidity and rest and postural tremor, but not bradykinesia, progressed significantly during the observation period. Progression of normalised segmental ratings for rigidity and tremor was significantly larger than the UPDRS-III ratings over 1 year. The segmental ratings for rigidity and tremor as well as their combination with the UPDRS-III bradykinesia rating were more sensitive a measure for progression of PD than the UPDRS-III.
  
  
  CONCLUSIONS
  Taking into account the segmental evolution of parkinsonian signs may be a useful adjunct to UPDRS-III evaluations to measure clinical disease progression of PD. If validated in subsequent larger cohorts, this may be useful in trials of neuroprotective agents.
authors.affiliation: Centre d'Investigation Clinique, Fédération des Maladies du Système Nerveux, Paris, France.
authors.forename: W M M
authors.initials: WM
authors.lastname: Schüpbach
authors.forename: J-C
authors.initials: JC
authors.lastname: Corvol
authors.forename: V
authors.initials: V
authors.lastname: Czernecki
authors.forename: M B
authors.initials: MB
authors.lastname: Djebara
authors.forename: J-L
authors.initials: JL
authors.lastname: Golmard
authors.forename: Y
authors.initials: Y
authors.lastname: Agid
authors.forename: A
authors.initials: A
authors.lastname: Hartmann
mesh_terms: D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009127:Muscle Rigidity / Q000175:diagnosis / Q000503:physiopathology; D010300:Parkinson Disease / Q000175:diagnosis / Q000503:physiopathology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014202:Tremor / Q000175:diagnosis / Q000503:physiopathology