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Neurodegenerative Disease Parkinson’s Disease

study recruits. It is possible that such patients would have very slowly progressing disease, making it difficult to apply the study results to patients found in normal clinical practice.68

In addition, those patients

who receive placebo during Phase 1 are more likely to drop out of the trial as a result of a lack of efficacy, which may cause a divergence in baseline characteristics and invalidate randomization.69

mentioned, in ADAGIO patients receiving placebo were allowed proceed to Phase 2 instead of discontinuing treatment.52

As previously Another

It is, however, not known whether PD progresses in a linear fashion, particularly in early disease when there is a rapid loss of dopaminergic cells.

New Developments in Parkinson’s Disease Assessment Scales

The Movement Disorder Society (MDS) has recently revised the UPDRS to include more non-motor measures and to make it less biased toward certain cultural practices.22

The revised scale, the MDS-UPDRS,

has four sections: •

• • •

section I: non-motor experiences of daily living; section II: motor experiences of daily living; section III: motor examination; and section IV: motor complications.66

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potential concern is that, by using slope estimates for measuring changes in UPDRS score, the data have been assumed to fit into a linear model.69


The UPDRS-ADL subscale is well known and commonly used to assess disease progression in PD. Moreover, it is quick for patients to self-complete. The ADAGIO trial provided an opportunity to assess the rate of change in UPDRS scores in a large sample of patients with early and untreated PD. Rasagiline treatment showed a potential disease-modifying effect, which supports its early use31,52

During the

ADAGIO trial, rasagiline treatment also delayed the need for additional antiparkinsonian drugs and reduced the non-motor symptom fatigue. Disease progression may be more accurately assessed using the UPDRS-ADL subscale than the UPDRS motor subscale, because the former includes both motor and non-motor components. If the non-motor symptoms in PD can be identified, and subsequently decreased through appropriate treatment, this may also slow the clinical progression of the disease.30,56

Future studies separating the assessment of motor and non-motor symptoms will help determine treatment success and how these symptoms modulate as the disease progresses. n

Parkinson disease: a small scale quasi-randomised trial, Trials, 2009;10:67.

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This scale has been validated for non-motor symptom assessment and correlation with the original UPDRS.70,71

In the MDS-UPDRS, motor and

non-motor ADL have been separated, so future trials using this scale will improve our understanding of the respective contribution of these parameters. Future rasagiline trials should help us understand how the assessment and subsequent treatment of non-motor symptoms might help improve the quality of life of patients with PD.

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