Objective: Objective: To determine the most sensitive combination of MDS-UPDRS Parts IB and II items that accurately predicted the clinically relevant target of dopaminergic therapy initiation.

Background: Background: The MDS-UPDRS Parts IB and 2 are self-reported items providing a direct patient voice to the experiences of PD.

Method: Methods: Utilizing a longitudinal cohort of de novo non-treated PD patients, we applied item response theory (IRT) and survival analysis to assess the relationship between baseline patient-reported symptoms and the later initiation of dopaminergic therapy. The 20 MDS-UPDRS Parts IB and II items were analyzed for their relationship to PD severity (discrimination) and the amount of information they provided in this determination (information). These parameters were used to develop models of predictive accuracy for initiation of dopaminergic therapy.

Results: Results: A six-item version of the MDS-UPDRS Part II provided a predictive accuracy for initiation of dopaminergic therapy superior to the full 20 items or any other combination. The 6-item version model showed a significantly higher C-index as compared to the full 20 item model (p=0.001).

Conclusion: Conclusions: A 6-item version of MDS-UPDRS of patient-reported items is a more efficient predictor of the key future clinical outcome of starting dopaminergic treatment in early PD. This study also demonstrates how IRT modeling can provide information useful to refining existing measures to identify the most sensitive combination of items honoring the voice of the patient in determining key clinically pertinent decisions.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/identifying-the-most-sensitive-patient-reported-items-from-the-mds-updrs-that-predict-initiation-of-pd-medications-in-early-disease/