How to identify tremor dominant and postural instability/gait difficulty groups with the movement disorder society unified Parkinson's disease rating scale: Comparison with the unified Parkinson's disease rating scale
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Background: Formulas were developed to define tremor dominant (TD) and postural instability/gait difficulty (PIGD) phenotypes of Parkinson's Disease (PD) using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). TD and PIGD designations, based on the original Unified Parkinson's Disease Rating Scale (UPDRS), provided useful designations for classifying different phenotypes of PD. With the advent of the MDS-UPDRS, a valid set of calculations for these phenotypes is needed. Methods: UPDRS and MDS-UPDRS scores were collected on 877 PD patients. TD/PIGD scores were calculated using the UPDRS formula for all patients. Comparable TD and PIGD items from the MDS-UPDRS were used to calculate new ratios. Data were analyzed using receiver operating characteristic models. Results: The new MDS-UPDRS TD/PIGD ratios accounted for a significant area under the curve compared with the UPDRS classification. Optimal sensitivity and specificity were obtained with MDS-UPDRS cutoff scores of 1.15 for TD classification and 0.90 for PIGD. Conclusions: The development of comparable and valid PIGD and TD scores from the MDS-UPDRS provides a clear method for clinicians and researchers to transition from the original UPDRS to the new MDSUPDRS in categorizing patients with different clinical phenotypes.
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