title: A proposal for a comprehensive grading of Parkinson's disease severity combining motor and non-motor assessments: meeting an unmet need.
abstract: BACKGROUND
  Non-motor symptoms are present in Parkinson's disease (PD) and a key determinant of quality of life. The Non-motor Symptoms Scale (NMSS) is a validated scale that allows quantifying frequency and severity (burden) of NMS. We report a proposal for using NMSS scores to determine levels of NMS burden (NMSB) and to complete PD patient classification.
  
  
  METHODS
  This was an observational, cross-sectional international study of 935 consecutive patients. Using a distribution of NMSS scores by quartiles, a classification based on levels from 0 (no NMSB at all) to 4 (very severe NMSB) was obtained and its relation with Hoehn and Yahr (HY) staging, motor and health-related quality of life scales was analyzed. Concordance between NMSB levels and grouping based on clinician's global impression of severity, using categorical regression, was determined. Disability and HRQoL predictors were identified by multiple regression models.
  
  
  RESULTS
  The distribution of motor and QoL scales scores by HY and NMSB levels was significantly discriminative. The difference in the classification of cases for both methods, HY and NMSB, was significant (gamma = 0.45; ASE = 0.032). Concordance between NMSB and global severity-based levels from categorical regression was 91.8%, (kappaw = 0.97). NMS score was predictor of disability and QoL.
  
  
  CONCLUSIONS
  Current clinical practice does not address a need for inclusion of non-motor scores in routine assessment of PD in spite of the overwhelming influence of NMS on disability and quality of life. Our data overcome the problems of "pure motor assessment" and we propose a combined approach with addition of NMSB levels to standard motor assessments.
authors.affiliation: National Parkinson Foundation Centre of Excellence, Kings College Hospital and Kings College, and University Hospital Lewisham, London, United Kingdom.
authors.forename: Kallol
authors.initials: K
authors.lastname: Ray Chaudhuri
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Rojo
authors.forename: Anthony H V
authors.initials: AH
authors.lastname: Schapira
authors.forename: David J
authors.initials: DJ
authors.lastname: Brooks
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Stocchi
authors.forename: Per
authors.initials: P
authors.lastname: Odin
authors.forename: Angelo
authors.initials: A
authors.lastname: Antonini
authors.forename: Richard G
authors.initials: RG
authors.lastname: Brown
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Brown
authors.forename: Pablo
authors.initials: P
authors.lastname: Martinez-Martin
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology*; D011788:Quality of Life; D012720:Severity of Illness Index
chemical_list: D000978:Antiparkinson Agents