Predicting ambulatory capacity in Parkinson's disease to analyze progression, biomarkers, and trial design

Venuto, C. S., Smith, G., Herbst, K., Zielinski, R., Yung, N. C.W., Grosset, D. G. , Dorsey, E. R. and Kieburtz, K. (2023) Predicting ambulatory capacity in Parkinson's disease to analyze progression, biomarkers, and trial design. Movement Disorders, (doi: 10.1002/mds.29519) (PMID:37363815) (Early Online Publication)

Abstract

Background: In Parkinson's disease (PD), gait and balance is impaired, relatively resistant to available treatment and associated with falls and disability. Predictive models of ambulatory progression could enhance understanding of gait/balance disturbances and aid in trial design. Objectives: To predict trajectories of ambulatory abilities from baseline clinical data in early PD, relate trajectories to clinical milestones, compare biomarkers, and evaluate trajectories for enrichment of clinical trials. Methods: Data from two multicenter, longitudinal, observational studies were used for model training (Tracking Parkinson's, n = 1598) and external testing (Parkinson's Progression Markers Initiative, n = 407). Models were trained and validated to predict individuals as having a “Progressive” or “Stable” trajectory based on changes of ambulatory capacity scores from the Movement Disorders Society Unified Parkinson's Disease Rating Scale parts II and III. Survival analyses compared time-to-clinical milestones and trial outcomes between predicted trajectories. Results: On external evaluation, a support vector machine model predicted Progressive trajectories using baseline clinical data with an accuracy, weighted-F1 (proportionally weighted harmonic mean of precision and sensitivity), and sensitivity/specificity of 0.735, 0.799, and 0.688/0.739, respectively. Over 4 years, the predicted Progressive trajectory was more likely to experience impaired balance, loss of independence, impaired function and cognition. Baseline dopamine transporter imaging and select biomarkers of neurodegeneration were significantly different between predicted trajectory groups. For an 18-month, randomized (1:1) clinical trial, sample size savings up to 30% were possible when enrollment was enriched for the Progressive trajectory versus no enrichment. Conclusions: It is possible to predict ambulatory abilities from clinical data that are associated with meaningful outcomes in people with early PD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

• Item Type: Articles
• Additional Information: Funding agencies: Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke (P50NS108676).
• Keywords: Prediction, progression model, clinical trial enrichment, Parkinson's disease progression, ambulatory capacity.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Grosset, Professor Donald
• Authors: Venuto, C. S., Smith, G., Herbst, K., Zielinski, R., Yung, N. C.W., Grosset, D. G., Dorsey, E. R., and Kieburtz, K.
• College/School: College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
• Journal Name: Movement Disorders
• Publisher: Wiley
• ISSN: 0885-3185
• ISSN (Online): 1531-8257
• Published Online: 26 June 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Movement Disorders 2023
• Publisher Policy: Reproduced under a Creative Commons License