Objective: To describe the prevalence of different motor phenotypes in a large cohort of Parkinson´s disease (PD) patients and to analyze their clinical features in detail.

Background: Different clinical phenotypes have been recognized in PD. Defining these subtypes clearly is needed to better understand underlying mechanisms and predict disease course.

Methods: The data were obtained from the baseline evaluation of the COPPADIS-Study, an observational, descriptive, 5-year follow-up, national (Spain), multicenter study (Santos García 2016). Three different motor phenotypes were considered─ Tremor Dominant (TD), Postural Instability Gait Difficulty (PIGD) and Indeterminate (ID) ─ based on a previously published formula (Jankovic 1990). Motor, non-motor, sociodemographic and PD-related variables were collected.

Results: Of 687 PD patients (62.8 ± 9 years old, 59.8% males) included, TD was the most frequent phenotype (45%), followed by PIGD (39.4%) and ID (15.6%). No differences in sex nor age were found between groups. TD patients presented lower non-motor symptoms burden compared to ID and PIGD (Non-Motor Symptoms Scale, 40.1 ± 34.8 vs 48.1 ± 37.3 vs 51.3 ± 41; p<0.0001), including lower pain scores (VAS-PAIN, 2.3 ± 2.8 vs 2.9 ± 3.1 vs 2.9 ± 3; p<0,0001) and lower fatigue scores (VAS-Fatigue, 2.4 ± 2.6 vs 3 ± 2.6 vs 3.6 ± 2.8; p<0,0001), better motor status (UPDRS part-III, 21.3 ± 10.6 vs 23.3 ± 10.9 vs 24.1 ± 12.2; p=0.02; UPDRS part-IV, 1.4 ± 1.9 vs 2.1 ± 2.5 vs 2.7 ± 2.6; p<0.0001) and better quality of life (QoL) (PDQ39, 14.6 ± 12.4 vs 19.4 ± 15.2 vs 19.1 ± 13.6; p<0.0001). On the contrary, the PIGD phenotype was associated to a longer disease duration compared to ID and TD (6.5 ± 4.6 years vs 5.6 ± 3.5 vs 4.7 ± 4.3; p<0.0001), more gait problems (Freezing of Gait Questionnaire, 5.4 ± 5.3 vs 3.8 ± 4.2 vs 2.3 ± 3.3; p<0.0001), depression (BDI-II, 10 ± 7.3 vs 8.7 ± 8.1 vs 7.8 ± 7.1; p<0.0001), neuropsychiatric symptoms (NPI, 7 ± 8.8 vs 5.5 ± 8.3 vs 5.6 ± 7.9; p<0,0001), and higher levodopa-equivalent daily dose (683.6 ± 469.3 vs 544.2 ± 349.3 vs 457.2 ± 353.6; p<0,0001).

Conclusions: According to previous studies, our findings suggest clear clinical differences between the defined PD motor phenotypes. While PIGD is the most severe phenotype, TD is the most benign with less motor and non-motor burden and better QoL.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-differences-between-parkinsons-disease-motor-phenotypes-results-from-the-coppadis-study-cohort/