![]() These studies can be costly to perform and challenging to standardize across sites due to factors such as the employment of novel pharmaceutical agents and advanced medical imaging techniques. Phase 2 and Phase 3 clinical trials for interventions that slow disease progression in Parkinsonism can have several sites within one country 8, 9 or multiple international sites 10, 11, 12. Although objective measures of dopamine transporter function, such as single photon emission computed tomography (DAT SPECT), free-water imaging, and positron emission tomography (F-DOPA PET), have shown good sensitivity and reliability in tracking disease progression in the first few years of being diagnosed with PD 2, 3, 4, 5, these assays can be time-consuming and expensive to implement on a wide scale and the DAT SPECT and F-DOPA PET can plateau after a few years post-diagnosis 6, 7. Currently, the common measures used to characterize motor disease progression in PD and atypical Parkinsonian disorders are subjective in nature, such as the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Moreover, related Parkinsonian syndromes, including multiple system atrophy (MSA) and progressive supranuclear palsy (PSP), present similarly to PD in early disease stages but have more advanced rates of decline and distinct pathological profiles. A major hurdle in PD is the scarcity of objective and reliable measures to assess the effectiveness of treatments potentially altering disease progression 1. Parkinson’s disease (PD) is a debilitating disorder characterized by both motor and non-motor manifestations and is the second most common neurodegenerative disease. Accelerometry in a subset of PD patients showed a diminished range of acceleration and irregular patterns of acceleration, which correlated with PPT scores. Neuroimaging measures from basal ganglia were significant predictors of PPT performance in PD, whereas cortical, basal ganglia, and cerebellar regions were predictors for atypical Parkinsonism. Parkinsonian patients showed a decline in PPT performance that correlated with motor symptom progression, which was not seen in controls. The goals of this study were to determine: (1) longitudinal changes in PPT in a multisite cohort of patients with PD, atypical Parkinsonism, and healthy controls (2) whether PPT performance reflects brain pathology revealed by neuroimaging (3) quantify kinematic deficits shown by PD patients during PPT. The Purdue Pegboard Test (PPT) is objective, has high test-retest reliability, and has a low cost. Objective measures of disease progression are critically needed in research on Parkinson’s disease (PD) and atypical Parkinsonism but may be hindered by both practicality and cost.
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