Objective: To explore culturally dependent differences between patient- and clinician-based evaluations of Parkinson’s disease (PD) motor symptoms.

Background: Effects of multiple demographic factors on Movement Disorder Society – Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) ratings have previously been reported. The effect of culture, as represented by language, on the relationship between the patient’s subjective perception and clinician’s objective rating of PD motor symptoms has not been investigated. Given that the cultural background of an individual affects the personal experience of PD dyskinesia¹, we extended the investigation of culture to PD primary motor symptoms and daily activities.

Method: The dataset included 8915 complete scales from the MDS-UPDRS Translation project. Twenty-five different languages contributed a minimum of 350 patients to the database. We examined the relationship of subjective ratings of motor experiences of daily living (MDS-UPDRS Part II) and clinician examination of motor symptomseverity (MDS-UPDRS Part III) for each language by calculating the ratio of subjective scores to objective scores and assessing intraclass correlation coefficients for rate of agreement. Post-hoc comparisons across the language ratios were run using a Scheffe correction for multiple comparisons. We included only patients with objective scores greater than 0.

Results: 8791 subjects were analyzed. Mean ratios of subjective to objective scores ranged from a high of 2.51 for the Hindi language to a low of 0.85 for the Romanian sample. The ratio of subjective to objective scores for Hindiwas significantly higher compared to all other languages. The ratio for Romanian was significantly lower compared to Hindi, Hebrew, Japanese, Kazakh and Turkish (all corrected p’s < 0.05). Intraclass correlation coefficients ranged from a high of 0.846 for Greek to a low of 0.322 for Dutch.

Conclusion: There are differences between language areas/cultures in regard to the personal experience of motor symptoms in PD. The observed differences need to be recognized in multinational clinical trials that use MDS-UPDRS, and in the clinical evaluation of PD patients from different cultural and linguistic backgrounds.

References: 1. Kaasinen V, Luo S, Martinez-Martin P, Goetz CG, Stebbins GT. Cross-Cultural Differences in Patient Perceptions of Dyskinesia in Parkinson’s Disease. Mov Disord 2023. https://doi.org/10.1002/mds.29335

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MDS Abstracts - https://www.mdsabstracts.org/abstract/intercultural-differences-in-patient-and-clinician-perceptions-of-mds-updrs-in-parkinsons-disease/