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Non-motor Classification and Subtypes
The classification based on NMSS has also given rise to the growing concept of non-motor dominant subtypes within PD. Just as in multiple sclerosis and motor neurone disease, clinical subtyping in PD is important (although some argue against this). Subtyping helps give a clearer definition of the clinical symptoms of PD as well as helping with inclusion criteria of patients for clinical trials. It also makes sense given the heterogeneity of neuropathological process underlying PD.
The groups of motor subtypes of PD include
tremor dominant
akinetic dominant
postural instability and gait disturbances
mixed.
Based on the dichotomy between non-motor symptom scores and motor scores in PD, non-motor classification of PD has been proposed, with five levels of non-motor symptoms burden (Box 2), as well as non-motor subtyping. A recent study identified four distinct clusters within PD: two were non-motor-dominant and benign mixed motor/non-motor (with prominent clinical expression of non-motor symptoms); the other two groups were motor-dominant and benign pure motor. We have proposed specific PD subtypes based on the predominance of key symptoms relevant to the early stage of PD; in the advanced stages, many of these subtypes may merge, as with motor subtypes. However, the natural history of these proposed subtypes at the moment remains unknown.
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