Objective: To quantify the extent to which self-perceived motor limitations (MDS-UPDRS part 2) relate to self-reported levels of non-motor symptom severity.

Background: The MDS-UPDRS part 2 is widely used to quantify self-perceived motor impairment related to Parkinson’s disease (PD). However, also non-motor symptoms may impact patients’ endorsement of motor problems in daily life. It is important to understand the degree to which non-motor symptoms may confound self-assessment of motor state, particularly if self-assessed motor ratings are used as outcome measures in clinical trials.

Method: Data from 316 individuals with early PD (<2 yrs) participating in a phase II clinical trial (PASADENA, NCT03100149) were analyzed. In this preliminary analysis, we compared individuals with higher self-rated MDS-UPDRS 2 than objective MDS-UPDRS 3 scores (“high self-raters”) to individuals with higher scores on part 3 than part 2 (“low self-raters”) on demographic, disease-related, and non-motor characteristics (i.e., Hospital Anxiety and Depression Survey [HADS-A, HADS-D], MDS-UPDRS 1) using Pearson’s Chi-squared and Mann-Whitney U-tests. Spearman’s correlations tested for associations between HADS, MDS-UPDRS, age, and gender. Multiple linear regression predicted MDS-UPDRS 2 from parts 1 and 3, HY stage, HADS, age, and gender.

Results: High self-raters did not differ from low self-raters in demographic, disease-related, or study-specific (i.e. study site, country) characteristics. However, high self-raters showed higher levels of depression (median=4 vs 2), anxiety (median=4 vs 3), and higher scores on MDS-UPDRS 1A (median=1 vs 0) and 1B (median=5 vs 3) (all U>9726, all p<.01). This was supported by a multiple linear regression predicting MDS-UPDRS 2 from part 1, part 3, and HADS-D (F[8, 290]=33.42, p<.001, R2=.47). Moreover, numerically higher positive correlations of MDS-UPDRS 2 with part 1A, part 1B, and HADS-D (rs[275]=.41, rs[275]=.53, and rs[275]=.45, respectively, all p<.001) than with part 3 were found (rs[275]=.27, p<.001). MDS-UPDRS 3 correlated neither with part 1 nor HADS.

Conclusion: Non-motor symptoms are associated with a tendency to report more motor symptoms in daily life, irrespective of clinician-evaluated motor signs. This needs consideration when the MDS-UPDRS part 2 is used to quantify motor symptom severity or treatment effects.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/endorsement-of-self-reported-non-motor-symptoms-is-associated-with-higher-self-rated-motor-experiences-of-daily-living-in-mds-updrs-part-2-in-parkinsons-disease/