Parkinson’s Disease: Outcome Variables and Clinical Scales

  • E. D. Playford


Parkinson’s disease is a progressive disorder characterised by tremor, rigidity, bradykinesia and postural instability. The aetiology, pathophysiology and clinical features all have a bearing on the selection of appropriate outcome measures and will be discussed briefly.


Stride Length Positron Emission Tomog SF36 Health Survey Questionnaire Dopa Uptake DATATOP Study 
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  1. 1.
    Marsden CD. Parkinson’s disease. Lancet 1990; 335: 948–952.PubMedCrossRefGoogle Scholar
  2. 2.
    Mann DMA, Yates PO. Possible role of neuromelanin in the pathogenesis of Parkinson’s disease. Mechanisms Ageing Dev 1983; 21: 193–203.CrossRefGoogle Scholar
  3. 3.
    Barbeau A. Aetiology of Parkinson’s disease: a research strategy. Can J Neurol Sci 1984; 11: 24–28.PubMedGoogle Scholar
  4. 4.
    Koller WC, Langston JW, Hubble JP, Irwin I, Zack M, Golbe L, et al. Does a long preclinical period occur in Parkinson’s disease? Neurology 1991; 41 (Suppl 2): 8–13.PubMedCrossRefGoogle Scholar
  5. 5.
    McGreer PL, et al. Rate of cell death in Parkinsonism indicates active neuropathological process. Ann Neurol 1988; 24: 574576.Google Scholar
  6. 6.
    Fearnley JM, Less AJ. Ageing and Parkinson’s disease: substantia nigra regional selectivity. Brain 1991; 114: 2283 2301.Google Scholar
  7. 7.
    Gibb WRG, Lees AJ. The significance of the Lewy body in the diagnosis of idiopathic Parkinson’s disease. Neuropathol Appl Neurobiol 1989; 15: 27–44.PubMedCrossRefGoogle Scholar
  8. 8.
    Alexander GE, DeLong MR, Strick PL. Parallel organisation of functionally segregated circuits linking basal ganglia and cortex. Annu Rev Neurosci 1986; 9: 357–381.PubMedCrossRefGoogle Scholar
  9. 9.
    Alexander GE, Cruthcher MD, DeLOng MR. Basal ganglia thalamo-cortical circuits: parallel substrates for motor, oculomotor, “prefrontal” and “limbic” functions. Prog Brain Res 1990; 85: 119–146.PubMedCrossRefGoogle Scholar
  10. 10.
    Duvoisin RC. The differential diagnosis of parkinsonism. In: Stern G, editor. Parkinson’s disease. London: Chapman and Hall Medical, 1990: 431–466.Google Scholar
  11. 11.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992; 55: 181–184.PubMedCrossRefGoogle Scholar
  12. 12.
    Ansorge O, Lees AJ, Daniel SE. Update on the accuracy of clinical diagnosis of idiopathic Parkinson’s disease. Mov Disord 1997(Suppl):359.Google Scholar
  13. 13.
    Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17: 427–442.PubMedCrossRefGoogle Scholar
  14. 14.
    The Parkinson Study Group. Effect of Deprenyl on the progression of disability in early Parkinson’s disease. N Engl J Med 1989; 321: 1364–1371.CrossRefGoogle Scholar
  15. 15.
    Poewe WH, Wenning GK. The natural history of Parkinson’s disease. Neurology 1996; 47: (Suppl 3): S146–152.PubMedCrossRefGoogle Scholar
  16. 16.
    Bonnet AM, Loria Y, Saint-Hilatre, Lhermitte F, Agid Y. Does long term aggravation of Parkinson’s disease result from nondopaminergic lesions? Neurology 1987; 37: 1539–1542.PubMedCrossRefGoogle Scholar
  17. 17.
    Goetz CG, Tanner CM, Shannon KM. Progression of Parkinson’s disease without levodopa. Neurology 1987; 37: 695–698.PubMedCrossRefGoogle Scholar
  18. 18.
    Ben Shlomo Y, Marmot MG. Survival and cause of death in a cohort of patients with parkinsonism: possible clues to aetiology. J Neurol Neurosurg Psychiatry 1995; 58: 293–299.CrossRefGoogle Scholar
  19. 19.
    Brown RG, Marsden CD. Neuropsychology and cognitive function in Parkinson’s disease: an overview. In: Marsden CD, Fahn S, editors. Movement disorders 2. London: Butterworth 1987.Google Scholar
  20. 20.
    Gotham AM, Brown RG, Marsden CD. Depression in Parkinson’s disease: a quantitative and qualitative analysis. J Neurol Neurosurg Psychiatry 1986; 49: 381–389.PubMedCrossRefGoogle Scholar
  21. 21.
    Marsden CD, Parkes JD. On-off effects in patients with Parkinson’s disease on chronic levodopa therapy. Lancet 1976; I: 29 2296.Google Scholar
  22. 22.
    Juncos JL, Engber TM, Raisman R, Susel Z, Thibaut F, Ploska A, et al. Continuous and intermittent levodopa differentially affect basal ganglia function. Ann Neurol 1989; 25: 473–478.PubMedCrossRefGoogle Scholar
  23. 23.
    Madrazo I, et al. Transplantation of fetal substantia nigra and adrenal medulla to the caudate nucleus in two patients with Parkinson’s disease. N Engl J Med 1988; 332: 1118–1124.Google Scholar
  24. 24.
    Lindvall O, Widner H, Rehncrona S, et al. Transplantation of foetal dopamine neurones in Parkinson’s disease: one year clinical and neurophysiological observations in two patients with putaminal implants. Ann Neurol 1992; 31: 155–165.PubMedCrossRefGoogle Scholar
  25. 25.
    Harby K. Using fetus derived tissues for molecular medicine: tension between research and ethics. Mol Med Today 1996; 2: 326–329.PubMedCrossRefGoogle Scholar
  26. 26.
    Boer GJ. Ethical guidelines for the use of human embryonic or foetal tissue for experimental and clinical neurotransplantation and research. Network of European CNS Transplantation and Restoration (NECTAR). J Neurol 1994; 242: 1–13.PubMedCrossRefGoogle Scholar
  27. 27.
    Northoff G. Do brain tissue transplants alter personality? Inadequacies of some standard arguments. J Med Ethics 1996; 22: 174–180.PubMedCrossRefGoogle Scholar
  28. 28.
    World Health Organization. International classification on impairments, disability and handicaps. Geneva: WHO, 1980.Google Scholar
  29. 29.
    Diamond SG, Markham CH. Evaluating the evaluations: or how to weigh the scales of parkinsonian disability. Neurology 1983; 33: 1098–1099.PubMedCrossRefGoogle Scholar
  30. 30.
    Henderson L, Kennard C, Crawford TJ, et al. Scales for rating motor impairment in Parkinson’s disease: studies of reliability and convergent validity. J Neurol Neurosurg Psychiatry 1991; 54: 18–24.PubMedCrossRefGoogle Scholar
  31. 31.
    Ward CD, Sanes JN, Dambrosia JM, Calne DB. Methods for evaluating treatment in Parkinson’s disease. In: Fahn S, Calne DB, Shoulson I, editors. Experimental therapeutics of movement disorders. Advances in neurology 37. New York: Raven Press, 1983.Google Scholar
  32. 32.
    Caligiuri MR. Portable device for quantifiying parkinsonian wrist rigidity. Mov Disorders 1994; 9: 57–63.CrossRefGoogle Scholar
  33. 33.
    Jankovic J, Frost JD. Quantitative assessment of parkinsonian and essential tremor: clinical application of tri-axial accelerometry. Neurology 1980; 30: 393.Google Scholar
  34. 34.
    Marsden CD, Schachter M. Assessment of extrapyramidal disorders. Br J Clin Pharmacol 1981; 11: 129–151.PubMedCrossRefGoogle Scholar
  35. 35.
    Jankovic J, Lang AC, Fahn S. High technology in the quantitation of movement disorders. Ninth international symposium on Parkinson’s disease, 1988.Google Scholar
  36. 36.
    Lakke JPWF. Assessment and measurement. In: Stern G, editor. Parkinson’s disease. London: Chapman and Hall Medical, 1990: 467–491.Google Scholar
  37. 37.
    Brooks DJ, Ibanez V, Sawle GV, Playford ED, Quinn N, Bannister R, et al. Striatal D2 receptor status in Parkinson’s disease, striatonigral degeneration, and progressive supranuclear palsy, measured with “C-raclopride and PET. Ann Neurol 1992; 31: 184–192.PubMedCrossRefGoogle Scholar
  38. 38.
    Playford ED, Brooks DJ. In vivo and in vitro measurements of the dopaminergic system in movement disorders. Cerebrovasc Brain Metab Rev 1992; 4: 144–171.PubMedGoogle Scholar
  39. 39.
    Garnett ES, Firnau G, Nahmias C. Dopamine visualised in the basal ganglia of living man. Nature 1983; 305: 137–138.PubMedCrossRefGoogle Scholar
  40. 40.
    Vingerhoets FJG, Snow BJ, Tetrud JW, Langston JW, Schulzer M, Calne DB. Positron emission tomographic evidence for progression of human MPTP induced dopaminergic lesions. Ann Neurol 1994; 36: 765–770.PubMedCrossRefGoogle Scholar
  41. 41.
    Pate BD, Kawamata T, Yamada T, McGreer EG, Hewitt KA, Snow BJ, et al. Correlation of striatal fluorodopa uptake in the MPTP monkey with dopaminergic indices. Ann Neurol 1993; 34: 331–338.PubMedCrossRefGoogle Scholar
  42. 42.
    Brooks DJ, Salmon EP, Mathias CJ, Quinn N, Leenders KL, Bannister R, et al. The relationship between locomotor disability, autonomic dysfunction and the integrity of the striatal dopaminergic system in patients with multiple system atrophy, primary autonomic failure and Parkinson’s disease studied with PET. Brain 1990; 113: 1539–1552.PubMedCrossRefGoogle Scholar
  43. 43.
    Takikawa S, Dhawan V, Chaly T, Robeson W, Dahl R, Zanzi I, et al. Input functions for 6-(fluorine-18)fluorodopa quantitation in parkinsonism: comparative studies and clinical correlations. J Nucl Med 1994; 35: 955–963.PubMedGoogle Scholar
  44. 44.
    Morrish PK, Sawle GV, Brooks DJ. An [18F]dopa-PET and clinical study of the rate of progression in Parkinson’s disease Brain 1996; 119: 585–591.Google Scholar
  45. 45.
    Sawle GV, Bloomfield PM, Bjorklund A, et al. Transplantation of foetal dopamine neurones in Parkinson’s disease: PET [18F]6-L-fluorodopa studies in two patients with putaminal implants. Ann Neurol 1992; 31: 166–173.PubMedCrossRefGoogle Scholar
  46. 46.
    Snow BJ, Tooyama I, Mcgreer EG, et al. Correlations in humans between postmortem PET fluorodopa uptake, postmortem dopaminergic cell counts and striatal dopaminergic levels. Ann Neurol 1993; 34: 324–330.PubMedCrossRefGoogle Scholar
  47. 47.
    Altman DG. Practical statistics for medical research. London: Chapman and Hall, 1991: 456.Google Scholar
  48. 48.
    Wade DT. Measurement in neurological rehabilitation. Oxford: Oxford University Press, 1992.Google Scholar
  49. 49.
    Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 1972; 1: 233–238.PubMedCrossRefGoogle Scholar
  50. 50.
    Katzman R, Brown T, Fuld P, Peck A, Schecter R, Schimmel H. Validation of a short Orientation-Memory-Concentration test of cognitive impairment. Am J Psychiatry 1983; 140: 734–739.PubMedGoogle Scholar
  51. 51.
    McDowell F, Lee JE, Swift T, Sweet RD, Ogsbury JS, Kessler T. Treatment of parkinson’s syndrome with L-dihydroxyphenylalanine (levodopa). Ann Intern Med 1970; 72: 29–35.PubMedGoogle Scholar
  52. 52.
    Yahr MD, Duvoisin RC, Schear MJ, et al. Treatment of Parkinsonism with levo-dopa. Arch Neurol 1969; 21: 343–354.PubMedCrossRefGoogle Scholar
  53. 53.
    Lieberman AN. Parkinson’s disease: a clinical review. Am J Med Sci 1974; 267: 66–80.PubMedCrossRefGoogle Scholar
  54. 54.
    Webster DD. Critical analysis of the disability in Parkinson’s disease. Mod Treatment 1968; 5: 257–282.Google Scholar
  55. 55.
    Alba A, Trainor FS, Ritter W, Dacso MM. A clinical rating scale for Parkinson patients. J Chron Dis 1968; 21: 507–522.PubMedCrossRefGoogle Scholar
  56. 56.
    Fahn S, Elton RL, and members of the UPDRS Development Committee. In: Fahn S, Marsden CD, Caine DB, Goldstein M, editors. Recent developments in Parkinson’s disease, vol 2. Florham Park, NJ: MachMillan Health Care Information, 1983: 153–165.Google Scholar
  57. 57.
    Hely MA, Chey T, Wilson A, et al. Reliability of the Columbia scale for assessing signs in Parkinson’s disease. Mov Disord 1993: 8: 466–472.PubMedCrossRefGoogle Scholar
  58. 58.
    Richards M, Marder K, Cote L, Mayeux R. Interrater reliability of the Unified Parkinson’s Disease Rating Scale Motor Examination. Mov Disord 1994; 9: 89–91.PubMedCrossRefGoogle Scholar
  59. 59.
    Louis ED, Lynch T, Marder K, Fahn S. Reliability of patient completion of the historical section of the unified Parkinson’s disease rating scale. Mov Disord 1996; 11: 185–192.PubMedCrossRefGoogle Scholar
  60. 60.
    Martinez-Martin P, Gil-Nagel A, Morlan Gracia L, Balseiro Gomez J, Martinez-Sarries J, Bermejo F, and the Co-operative Multicentric Group. Unified Parkinson’s disease rating scale characteristics and structure. Mov Disord 1994; 9: 76–83.CrossRefGoogle Scholar
  61. 61.
    Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361–370.PubMedCrossRefGoogle Scholar
  62. 62.
    Folstein MF, Folstein SE, McHugh PJ. “Mini-mental state”: a practical method for grading the cognitive state of patients for clinicians. J Psychiatr Res 1975; 12: 189–198.PubMedCrossRefGoogle Scholar
  63. 63.
    Reynold NC, Montgomery GK. Factor analysis of Parkinson’s impairment: an evaluation of the final common pathway. Arch Neurol 1987; 44: 1013–1016.CrossRefGoogle Scholar
  64. 64.
    Van Hilten JJ, van der Zwan AD, Zwinderman AH, Roos RA. Rating impairment and disability in Parkinson’s disease: evaluation of the Unified Parkinson’s Disease Rating Scale. Mov Disord 1994; 9: 84–88.PubMedCrossRefGoogle Scholar
  65. 65.
    Langston JW, Widner H, Goetz CG, et al. Core Assessment Program for Intracerebral Transplantation (CAPIT). Mov Disord 1992; 7: 2–13.PubMedCrossRefGoogle Scholar
  66. 66.
    Canter GJ, De la torre R, Mier M. A method for evaluating disability in patients with Parkinson’s disease. J Nery Ment Dis 1961; 133: 143–147.CrossRefGoogle Scholar
  67. 67.
    Brown RG, MacCarthy B, Jahanshahi M, Marsden CD. Accuracy of self reported disability in patients with parkinsonism. Arch Neurol 1989; 46: 955–959.PubMedCrossRefGoogle Scholar
  68. 68.
    Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Maryland State Med J 1965; 14: 61–65.Google Scholar
  69. 69.
    Wade DT, Collin C. The Barthel ADL index: a standard measure of physical disability? Int Disability Studies 1988; 10: 64–67.CrossRefGoogle Scholar
  70. 70.
    Nonni FM, Lincoln NB. An extended activities of daily living scale for stroke patients. Clin Rehabil 1987; 1: 301–305.CrossRefGoogle Scholar
  71. 71.
    Mathiowetz V, Weber K, Kashman N, Volland G. Adult norms for the nine hole peg test of finger dexterity. Occup Ther J Res 1985; 5: 24–37.Google Scholar
  72. 72.
    Yekutiel MP, Pinhasov A, Shahar G, Sroka H. A clinical trial of the re-education of movement in patients with Parkinson’s disease. Clin Rehabil 1991; 5: 207–214.CrossRefGoogle Scholar
  73. 73.
    Nieuwboer A, et al. Is using a cue the clue to the treatment of freezing in Parkinson’s disease? Physiother Res Int 1997; 2: 125–132.PubMedCrossRefGoogle Scholar
  74. 74.
    A symposium on the minimal record of disability. Acta Neurol Scand 1984; 101 (Suppl): 167–207.Google Scholar
  75. 75.
    Hunt SM, McKenna SP, McEwan J, et al. A quantitative approach to perceived health status: a validation study. J Epidemiol Community Health 1980; 34: 281–286.PubMedCrossRefGoogle Scholar
  76. 76.
    Schindler JS, Brown R, Welburn P, Parkes JD. Measuring the quality of life in patients with Parkinson’s disease. In: Walter SR, Rosser R, editors. Quality of life: assessment and application. Lancaster: MTP Press, 1987: 223–234.Google Scholar
  77. 77.
    Jenkinson C, Coulter A, Wright L. Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. BMJ 1993; 306: 1437–1440.PubMedCrossRefGoogle Scholar
  78. 78.
    Garratt AM, Ruta DA, Abdalla MI, Buckingham JK, Russell IT. The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS. BMJ 1993; 306: 1440 1444.Google Scholar
  79. 79.
    Peto V, Fitzpatrick R, Jenkinson C. Self reported health status and access to health services in a community sample with Parkinson’s disease. Disabil Rehabil 1997; 19: 97103.CrossRefGoogle Scholar
  80. 80.
    Jenkinson C, Peto V, Fitzpatrick R, Greenhall R, Hyman N. Self reported functioning and well-being in patients with Parkinson’s disease: comparison of the short-form health survey (SF36) with the Parkinson’s disease questionnaire (PDQ 39). Age Ageing 1995; 24: 505–509.PubMedCrossRefGoogle Scholar
  81. 81.
    Schwartz D, Flanmant R, Llelouch J. Clinical trials. New York: Academic Press, 1991.Google Scholar
  82. 82.
    Ward CD. Does selegiline delay progression of Parkinson’s disease? A critical re-evaluation of the DATATOP study. J Neurol Neurosurg Psychiatry 1994; 57: 217–220.PubMedCrossRefGoogle Scholar
  83. 83.
    Lang AE, Quinn N, Brincat S, Marsden CD, Parkes JD. Pergolide in late stage Parkinson’s disease. Ann Neurol 1982; 12: 243247.Google Scholar
  84. 84.
    Tanner GM, Goetz CG, Glantz RH, Glatt SL, Klawans HL. Pergolide mesylate and idiopathic Parkinson disease. Neurology 1982; 32: 1175–1179.PubMedCrossRefGoogle Scholar
  85. 85.
    Lieberman A, Goldstein M, Leibowitz M. The effect of pergolide on the cardiovascular system of forty patients with Parkinson’s disease. Adv Neurol 1984; 37: 121–130.Google Scholar
  86. 86.
    Olanow CW, Fahn S, Muenter M, et al. A multicenter Intracerebral Transplantation [letter]. Mov Disord 1995;10:double blind placebo-controlled trial of Pergolide as an 527–528.Google Scholar
  87. 87.
    Obeso JA, Guridi J, DeLong M. Surgery for Parkinson’s disease. 1994; 117: 1169–1181.Google Scholar
  88. 88.
    Lang AE, Benabid A-L, Koller WC, Lozano AM, Obeso JA, Olanow CW, Pollak P. The Core Assessment Program for Intracerebral Transplantation [letter]. Mov Disord 1995;10: 527-528.Google Scholar
  89. 89.
    ME, lansek R, Matyas TA, Summers JJ. The pathogenesis of gait hypokinesia in Parkinson’s disease. Brain 1994;117:1169-1181.Google Scholar
  90. 90.
    . Margitic SE, Morgan TM, Sager MA, Furberg CD. Lessons learned from a prospective metanalyis. J Am Geriatr Soc 1995;43:435-439.Google Scholar

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  • E. D. Playford

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