A composite clinical motor score as a comprehensive and sensitive outcome measure for Parkinson's disease

Christine Lo*, Siddharth Arora, Michael Lawton, Thomas Barber, Timothy Quinnell, Gary J Dennis, Yoav Ben-Shlomo, Michele Tao-Ming Hu

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)
30 Downloads (Pure)


BACKGROUND: An unmet need remains for sensitive outcome measures in neuroprotective trials. The study aims to determine whether a composite clinical motor score, combining the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III motor examination score, Purdue Pegboard Test, and Timed Up and Go, provides greater sensitivity in detecting motor change in early disease than the MDS-UPDRS III alone.

METHODS: The Oxford Discovery longitudinal cohort study involves individuals with isolated rapid eye movement sleep behaviour disorder (iRBD) (n=272, confirmed polysomnographically, median follow-up: 1.6 years), idiopathic Parkinson's disease (PD) (n=909, median follow-up: 3.5 years, baseline: <3.5 years disease duration) and controls (n=316, age-matched and sex-matched, without a first-degree family history of PD). Motor and non-motor assessments were performed at each in-person visit.

RESULTS: Compared with the MDS-UPDRS III, the composite clinical motor score demonstrated a wider score distribution in iRBD and controls, lower coefficient of variation (37% vs 67%), and higher correlation coefficients with self-reported measures of motor severity (0.65 vs 0.61) and overall health status (-0.40 vs -0.33). Greater score range in mild to moderate PD, higher magnitude of longitudinal change in iRBD and longitudinal score linearity suggest better sensitivity in detecting subtle motor change. The composite clinical motor score was more accurate than the MDS-UPDRS III in predicting clinical outcomes, requiring 64% fewer participants with PD and 51% fewer participants with iRBD in sample size estimations for a hypothetical 18-month placebo-controlled clinical trial.

CONCLUSION: The composite clinical motor score may offer greater consistency and sensitivity in detecting change than the MDS-UPDRS III.

Original languageEnglish
Article number327880
Pages (from-to)617-624
Number of pages8
JournalJournal of Neurology, Neurosurgery, and Psychiatry
Issue number6
Early online date6 Apr 2022
Publication statusE-pub ahead of print - 6 Apr 2022

Bibliographical note

Funding Information:
Funding This study was funded by the Monument Trust Discovery Award from Parkinson’s UK (J-1403) and supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC).

Funding Information:
Competing interests CL was funded by the NIHR Oxford BRC. TB was funded by the Wellcome Trust Doctoral Training Fellowship. TQ is currently a short term Consultant for Jazz Pharmaceuticals and a CI for an NIHR grant for a therapeutic trial in OSA.

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