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NEUROLOGY 2009;73:1584-1591
© 2009 American Academy of Neurology

International study on the psychometric attributes of the Non-Motor Symptoms Scale in Parkinson disease

P. Martinez-Martin, MD, PhD, C. Rodriguez-Blazquez, BSc, K. Abe, MD, K. B. Bhattacharyya, MD, B. R. Bloem, MD, PhD, F. J. Carod-Artal, MD, PhD, R. Prakash, MD, R.A.J. Esselink, MD, C. Falup-Pecurariu, MD, M. Gallardo, MD, P. Mir, MD, PhD, Y. Naidu, BSc, A. Nicoletti, MD, K. Sethi, MD, FRCP, Y. Tsuboi, MD, J. J. van Hilten, MD, PhD, M. Visser, PhD, M. Zappia, MD and K. R. Chaudhuri, MD

From the National Centre of Epidemiology and CIBERNED (P.M.-M., C.R.-B.), Carlos III Institute of Health, Madrid, Spain; Department of Neurology and Rehabilitation (K.A.), Konan Women’s University and Konan Hospital, Kobe, Japan; Department of Neuromedicine (K.B.B.), Burdwan Medical College and Hospital, Bangur Institute of Neuroscience and Psychiatry, Calcutta, India; Department of Neurology (B.R.B., R.A.J.E.), Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands; Department of Neurology (F.J.C.-A.), Sarah Hospital, Brasilia, Brazil; Department of Neurology (R.P., K.S.), Medical College of Georgia, Augusta, GA; Department of Neurology (C.F.-P.), Transilvania University, Brasov, Romania; Movement Disorders Unit (M.G.), Hospital Dr. Domingo Luciani, Caracas, Venezuela; Movement Disorders Unit (P.M.), Department of Neurology, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/U. de Sevilla and CIBERNED, Seville, Spain; Department of Neurology (Y.N.), University Hospital Lewisham, London, UK; Neurosciences Department (A.N., M.Z.), University of Catania, Italy; Department of Neurology (Y.T.), Fukuoka University Hospital, Japan; Department of Neurology (J.J.v.H., M.V.), Leiden University Medical Center, The Netherlands; National Parkinson Foundation Centre of Excellence (K.R.C.), Kings College Hospital, and Department of Neurology, University Hospital Lewisham, London, UK.

Address correspondence and reprint requests to Dr. P. Martinez-Martin, National Center of Epidemiology, Carlos III Institute of Health, Av. Monforte de Lemos, 3, 28029 Madrid, Spain pmartinez{at}isciii.es

Background: Nonmotor symptoms (NMS) have a great impact on patients with Parkinson disease (PD). The Non-Motor Symptoms Scale (NMSS) is an instrument specifically designed for the comprehensive assessment of NMS in patients with PD. NMSS psychometric properties have been tested in this study.

Methods: Data were collected in 12 centers across 10 countries in America, Asia, and Europe. In addition to the NMSS, the following measures were applied: Scales for Outcomes in Parkinson’s Disease (SCOPA)-Motor, SCOPA-Psychiatric Complications (SCOPA-PC), SCOPA-Cognition, Hoehn and Yahr Staging (HY), Clinical Impression of Severity Index for Parkinson’s Disease (CISI-PD), SCOPA-Autonomic, Parkinson’s Disease Sleep Scale (PDSS), Parkinson’s Disease Questionnaire–39 items (PDQ-39), and EuroQol–5 dimensions (EQ-5D). NMSS acceptability, reliability, validity, and precision were analyzed.

Results: Four hundred eleven patients with PD, 61.3% men, were recruited. The mean age was 64.5 ± 9.9 years, and mean disease duration was 8.1 ± 5.7 years. The NMSS score was 57.1 ± 44.0 points. The scale was free of floor or ceiling effects. For domains, the Cronbach {alpha} coefficient ranged from 0.44 to 0.85. The intraclass correlation coefficient (0.90 for the total score, 0.67–0.91 for domains) and Lin concordance coefficient (0.88) suggested satisfactory reproducibility. The NMSS total score correlated significantly with SCOPA-Autonomic, PDQ-39, and EQ-5D (rS = 0.57–0.70). Association was close between NMSS domains and the corresponding SCOPA–Autonomic domains (rS = 0.51–0.65) and also with scales measuring related constructs (PDSS, SCOPA-PC) (all p < 0.0001). The NMSS total score was higher for women (p < 0.02) and for increasing disease duration, HY, and CISI-PD severity level (p < 0.001). The SEM was 13.91 for total score and 1.71 to 4.73 for domains.

Conclusion: The Non-Motor Symptoms Scale is an acceptable, reproducible, valid, and precise assessment instrument for nonmotor symptoms in Parkinson disease.

Abbreviations: CCC = concordance correlation coefficient; CISI-PD = Clinical Impression of Severity Index for Parkinson’s Disease; EQ-5D = EuroQol–5 dimensions; HRQL = health-related quality of life; HY = Hoehn and Yahr Staging; ICC = intraclass correlation coefficient; IRB = institutional review board; MDS-UPDRS = Movement Disorder Society–sponsored revision of the Unified Parkinson’s Disease Rating Scale; NMS = nonmotor symptoms; NMSQuest = Non-Motor Symptoms Questionnaire; NMSS = Non-Motor Symptoms Scale; PD = Parkinson disease; PDQ-39 = Parkinson’s Disease Questionnaire–39 items; PDSS = Parkinson’s Disease Sleep Scale; SCOPA = Scales for Outcomes in Parkinson’s Disease; SCOPA-AUT = Scales for Outcomes in Parkinson’s Disease–Autonomic; SCOPA-COG = Scales for Outcomes in Parkinson’s Disease–Cognition; SCOPA-M = Scales for Outcomes in Parkinson’s Disease–Motor; SCOPA-PC = Scales for Outcomes in Parkinson’s Disease–Psychiatric Complications; SEM = standard error of measurement; UPDRS = Unified Parkinson’s Disease Rating Scale; VAS = visual analog scale.

Disclosure: Author disclosures are provided at the end of the article.

Statistical analysis was performed by P. Martinez-Martin and C. Rodriguez-Blazquez.

Received January 26, 2009. Accepted in final form August 12, 2009.






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