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The International Parkinson and Movement Disorder Society - Non-Motor Rating Scale (MDS-NMS)
Availability
Please visit this website for more information about the instrument: The International Parkinson and Movement Disorder Society - Non-Motor Rating Scale
Classification
Supplemental - Highly Recommended: Parkinson's Disease (PD)
Recommendations for use: Indicated for studies use in clinical trials of disease-modifying and/or symptomatic treatments of PD as a broad inclusive measure of the burden of non-motor manifestations.
Short Description of Instrument
The MDS-NMS is a revised version of the Non-Motor Symptoms Scale (NMSS). It is an assessment of non-motor symptoms in Parkinson's disease (PD).
 
The scale is rater-completed. Frequency and severity of PD and treatment related non-motor symptoms are measured across 13 non-motor domains. This version goes into greater detail than the previous NMSS.
 
A new MDS-NMS Non-Motor Fluctuations (NMF) subscale was added to this version. The subscale includes 8 domains. Questions assess change in non-motor symptoms in relation to the timing of anti-parkinsonian medications.
Comments/Special Instructions
The MDS expects this scale will have utility in clinical care and research, including trials of investigational medicinal products related to PD.
Scoring and Psychometric Properties
The scale has 52 items which are grouped into 13 domains based on clinical content.
 
Scoring:
Each question has a frequency and severity score (0-4):
Frequency:
0 = Never
1 = Rarely
2 = Sometimes
3 = Frequently
4 = Majority of the time
Severity:
0 = Not present
1 = Minimal
2 = Mild
3 = Moderate
4 = Severe
 
Frequency and severity scores are then multiplied to generate the item total score. Scores for each domain and the total rating scale are calculated by adding the corresponding items. The total rating scale maximum possible is 832 points.
 
The NMF subscale has 8 items. Domains included are depression, anxiety, thinking or cognitive abilities, bladder symptoms, restlessness, pain, fatigue, and excessive sweating.
 
Each question is scored for typical degree of change from "on" to "off" periods (0-4):
0 = No change
1 = Minimal
2 = Small
3 = Medium
4 = Large
 
Time spent in non-motor "off" state is assessed (1-4):
1 = Rarely
2 = Sometimes
3 = Frequently
4 = Majority of time
 
The subscale score is calculated by multiplying the total of degree of change for the 8 items by the amount of time spent in the "off" state with NMSs. The maximum possible score is 128.
 
Psychometric Properties:
    • Excellent test re-test and inter-rater reliability

    • Acceptable internal consistency

    • Great precision metrics

    • No ceiling / floor effects

Rationale/Justification
Strengths:
    • Comprehensive assessment of various NMSs.

    • Assesses frequency and severity of NMSs.

    • Addresses non-motor fluctuations.

    • Includes non-specific symptoms.

 
Weaknesses:
    • Performance not assessed in more severe disease.

    • Sensitivity to change is unknown.
References
Key Reference:
Martinez-Martin P, Schrag A, Weintraub D, Rizos A, Rodriquez-Blazquez C, Chaudhuri KR. Pilot Study of the International Parkinson and Movement Disorder Society-Sponsored Non-motor Rating Scale (MDS-NMS). Movement Disorders Clinical Practice. 2019 Jan;6(3):227-234.
 
Additional References:
Chaudhuri KR, Martinez-Martin P, Brown RG, Sethi K, Stocchi F, Odin P, Ondo W, Abe K, Macphee G, Macmahon D, Barone P, Rabey M, Forbes A, Breen K, Tluk S, Naidu Y, Olanow W, Williams AJ, Thomas S, Rye D, Tsuboi Y, Hand A, Schapira AH. The metric properties of a novel non-motor symptoms scale for Parkinson's disease: Results from an international pilot study. Mov Disord. 2007 Oct 15;22(13):1901-11.
 
Chaudhuri KR, Martinez-Martin P, Schapira AH, Stocchi F, Sethi K, Odin P, Brown RG, Koller W, Barone P, MacPhee G, Kelly L, Rabey M, MacMahon D, Thomas S, Ondo W, Rye D, Forbes A, Tluk S, Dhawan V, Bowron A, Williams AJ, Olanow CW. International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: the NMSQuest study. Mov Disord. 2006 Jul;21(7):916-23.
 
Chaudhuri KR, Schrag A, Weintraub D, Rizos A, Rodriguez-Blazquez C, Mamikonyan E, Martinez-Martin P. The movement disorder society nonmotor rating scale: Initial validation study. Mov Disord. 2020 Jan;35(1):116-133.
 
Martinez-Martin P, Rodriguez-Blazquez C, Abe K, Bhattacharyya KB, Bloem BR, Carod-Artal FJ, Prakash R, Esselink RA, Falup-Pecurariu C, Gallardo M, Mir P, Naidu Y, Nicoletti A, Sethi K, Tsuboi Y, van Hilten JJ, Visser M, Zappia M, Chaudhuri KR. International study on the psychometric attributes of the non-motor symptoms scale in Parkinson disease. Neurology. 2009 Nov 10;73(19):1584-91.
 
Martinez-Martin P, Rojo-Abuín JM, Weintraub D, Chaudhuri K, Rodriguez-Blázquez C, Rizos A, Schrag A. Factor Analysis and Clustering of the Movement Disorder Society-Non-Motor Rating Scale. Mov Disord. 2020 Jun;35(6):969-975.
 
Rodriguez-Blazquez C, Forjaz MJ, Frades-Payo B, de Pedro-Cuesta J, Martinez-Martin P; Longitudinal Parkinson's Disease Patient Study, Estudio Longitudinal de Pacients con Enfermedad da Parkinson Group. Independent validation of the scales for outcomes in Parkinson's disease-autonomic (SCOPA-AUT). Eur J Neurol. 2010 Feb;17(2):194-201.
 
Document Last Updated August 2022