15 April 2009
Evatt ML, Chaudhuri KR,
Chou KL, Cubo E, Hinson V, Kompoliti K, Yang C, Poewe W, Rascol O, Sampaio C, Stebbins GT, Goetz CG
Upper and lower gastrointestinal dysautonomia symptoms
(GIDS)—sialorrhea, dysphagia, and constipation are common in Parkinson's
disease (PD) and often socially as well as physically disabling for
patients. Available invasive quantitative measures for assessing these
symptoms and their response to therapy are time-consuming, require
specialized equipment, can cause patient discomfort and present patients
with risk.
The Movement Disorders Society commissioned a task force to
assess available clinical rating scales, critique their clinimetric
properties, and make recommendations regarding their clinical utility.
Six clinical researchers and a biostatistician systematically searched
the literature for scales of sialorrhea, dysphagia, and constipation,
evaluated the scales' previous use, performance parameters, and quality
of validation data (if available). A scale was designated “Recommended”
if the scale was used in clinical studies beyond the group that
developed it, has been specifically used in PD reports, and clinimetric
studies have established that it is a valid, reliable, and sensitive.
“Suggested” scales met at least part of the above criteria, but fell
short of meeting all. Based on the systematic review, scales for
individual symptoms of sialorrhea, dysphagia, and constipation were
identified along with three global scales that include these symptoms in
the context of assessing dysautonomia or nonmotor symptoms. Three
sialorrhea scales met criteria for Suggested: Drooling Severity and
Frequency Scale (DSFS), Drooling Rating Scale, and Sialorrhea Clinical
Scale for PD (SCS-PD). Two dysphagia scales, the Swallowing Disturbance
Questionnaire (SDQ) and Dysphagia-Specific Quality of Life (SWAL-QOL),
met criteria for Suggested. Although Rome III constipation module is
widely accepted in the gastroenterology community, and the earlier
version from the Rome II criteria has been used in a single study of PD
patients, neither met criteria for Suggested or Recommended.
Among the
global scales, the Scales for Outcomes in PD-Autonomic (SCOPA-AUT) and
Nonmotor Symptoms Questionnaire for PD (NMSQuest) both met criteria for
Recommended, and the Nonmotor Symptoms Scale (NMSS) met criteria for
Suggested; however, none specifically focuses on the target
gastrointestinal symptoms (sialorrhea, dysphagia, and constipation) of
this report. A very small number of rating scales have been applied to
studies of gastrointestinal-related dysautonomia in PD.
Only two scales
met “Recommended” criteria and neither focuses specifically on the
symptoms of sialorrhea, dysphagia, and constipation. Further scale
testing in PD among the scales that focus on these symptoms is
warranted, and no new scales are needed until the available scales are
fully tested clinimetrically.
