Mokken scale analysis of the UPDRS: dimensionality of the Motor Section revisited

The dimensionality and reliability of the Motor Section of the Unified Parkinson Disease Rating Scale (UPDRS III) was studied with non-parametric Mokken scale analysis. UPDRS measures were obtained on 147 patients with PD (96 men, 51 women, mean age 61, range 35-80 yrs). Mokken scale analysis revealed a four-dimensional structure of the UPDRS III. Left-sided bradykinesia and rigidity appeared to co-occur with axial signs, gait disturbance, and speech/hypomimia, whereas right-sided bradykinesia and rigidity formed a second scale. Two further small scales were found consisting of right- and left-sided tremor. Results from the scale analysis reveal that all four subscales are strong. The reliability of the two tremor scales is low because they only contain three and four items, respectively.     

Quantitative normative gait data in a large cohort of ambulatory persons with Parkinson's disease

Background

Gait performance is widely evaluated to assess health status in older adult populations. While several investigators have presented normative values for spatiotemporal gait parameters drawn from older adult populations, the literature has been void of large-scale cohort studies, which are needed in order to provide quantitative, normative gait data in persons with Parkinson’s disease. The aim of this investigation was to provide reference values for clinically important gait characteristics in a large sample of ambulatory persons with Parkinson’s disease to aid both clinicians and researchers in their evaluations and treatments of gait impairment.

Methodology/Principal Findings

Gait performance was collected in 310 individuals with idiopathic Parkinson’s disease as they walked across a pressure sensitive walkway. Fourteen quantitative gait parameters were measured and evaluated with respect to Hoehn and Yahr disease staging and gender. Disease duration and age were controlled for in all analyses. Individuals with the greatest Parkinson’s disability walked significantly slower with shorter steps and stride lengths than the mild and moderately affected groups. Further, the most affected patients spent more time with both feet on the ground, and walked with a wider base of support than the moderately disabled patients. No differences were detected between the mild and moderate disability groups on any of the gait parameters evaluated.

Conclusions/Significance

Reference values for 14 gait parameters in a large cohort of ambulatory patients with Parkinson’s disease are provided and these may be highly useful for assessing and interpreting an individual’s gait dysfunction. It is important for clinicians and researchers to appreciate the lack of change in quantitative parameters as PD patients move from mild to moderate gait impairment.     

Motor Performance Assessment in Parkinson’s Disease: Association between Objective In-Clinic,Objective In-Home,and Subjective/Semi-Objective Measures

Advances in wearable technology allow for the objective assessment of motor performance in both in-home and in-clinic environments and were used to explore motor impairments in Parkinson’s disease (PD). The aims of this study were to: 1) assess differences between in-clinic and in-home gait speed, and sit-to-stand and stand-to-sit duration in PD patients (in comparison with healthy controls); and 2) determine the objective physical activity measures, including gait, postural balance, instrumented Timed-up-and-go (iTUG), and in-home spontaneous physical activity (SPA), with the highest correlation with subjective/semi-objective measures, including health survey, fall history (fallers vs. non-fallers), fear of falling, pain, Unified Parkinson''s Disease Rating Scale, and PD stage (Hoehn and Yahr). Objective assessments of motor performance were made by measuring physical activities in the same sample of PD patients (n = 15, Age: 71.2±6.3 years) and age-matched healthy controls (n = 35, Age: 71.9±3.8 years). The association between in-clinic and in-home parameters, and between objective parameters and subjective/semi-objective evaluations in the PD group was assessed using linear regression-analysis of variance models and reported as Pearson correlations (R). Both in-home SPA and in-clinic assessments demonstrated strong discriminatory power in detecting impaired motor function in PD. However, mean effect size (0.94±0.37) for in-home measures was smaller compared to in-clinic assessments (1.30±0.34) for parameters that were significantly different between PD and healthy groups. No significant correlation was observed between identical in-clinic and in-home parameters in the PD group (R = 0.10–0.25; p>0.40), while the healthy showed stronger correlation in gait speed, sit-to-stand duration, and stand-to-sit duration (R = 0.36–0.56; p<0.03). This suggests a better correlation between supervised and unsupervised motor function assessments in healthy controls compared to PD group. In the PD group, parameters related to velocity and range-of-motion of lower extremity within gait assessment (R = 0.58–0.84), and turning duration and velocity within iTUG test (R = 0.62–0.77) demonstrated strong correlations with PD stage (p<0.01).     

Discriminating age and disability effects in locomotion: neuromuscular adaptations in musculoskeletal pathology.

We identified biomechanical variables indicative of lower extremity dysfunction, distinct from age-related gait adaptations, and examined interrelationships among these variables to better understand the neuromuscular adaptations in gait. Sagittal plane ankle, knee, and hip peak angles, moments, and powers and spatiotemporal parameters were acquired during preferred-speed gait in 120 subjects: 45 healthy young, 37 healthy elders, and 38 elders with functional limitations due to lower extremity musculoskeletal pathology, primarily arthritis. Multiple analysis of covariance with discriminate analysis, adjusted for gait speed, was used to identify the variables discriminating groups. Correlation analysis was used to explore interrelationships among these variables within each group. Healthy elders were discriminated (sensitivity 76%, specificity 82%) from young adults via decreased late-stance ankle plantar flexion angle, increased late-stance knee power absorption, and early-stance hip extensor power generation. Disabled elders were discriminated (sensitivity 74%, specificity 73%) from healthy elders via decreased late-stance ankle plantar flexor moment and power generation, increased early-stance ankle dorsiflexor moment, and late-stance hip flexor moment and power absorption. Relationships among variables showed a higher degree of coupling for the disabled elders compared with the healthy groups, suggesting a reduced ability to alter motor strategies. Our data suggest that, beyond age-related changes, elders with lower extremity dysfunction rely excessively on passive action of hip flexors to provide propulsion in late stance and contralateral ankle dorsiflexors to enhance stability. These findings support a growing body of evidence that gait changes with age and disablement have a neuromuscular basis, which may be informative in a motor control framework for physical therapy interventions.     

Altered joint kinetic strategies of healthy older adults and individuals with Parkinson’s disease to walk at faster speeds

Individuals with Parkinson’s disease (PD) exhibit poorer walking performance compared to healthy, age-matched adults. Lower extremity joint kinetics may provide insight into this performance deficit but are currently lacking in the PD literature, especially across multiple speeds. The primary purpose of this study was to compare joint kinetics between individuals with PD and healthy older adults at both comfortable and maximal walking speeds. Secondarily, we quantified relationships between joint kinetics and walking speeds within each group. Biomechanical gait analyses were conducted for 13 individuals with PD and 12 age-matched controls during comfortable (CWS) and maximal (MWS) speed walking. Relative contributions to total positive work from the hip, knee, and ankle were compared across groups and speeds. Within each group, relationships between relative joint work and CWS and MWS were also quantified. Significant group by speed interactions indicated that healthy older adults increased hip and decreased ankle relative work at MWS compared to CWS whereas relative work at all joints in PD group remained stable across speeds. In the older group, positive relationships were observed between relative hip work and MWS. In the PD group, negative relationships were observed between relative hip work and CWS and MWS. Healthy older adults disproportionately increased mechanical contributions from the hip at MWS compared to CWS. Individuals with PD did not exhibit similar disproportionate scaling of joint kinetics across speed conditions. Inability to appropriately scale joint kinetics in PD may represent an inflexible neuromuscular system in PD, which may limit walking performance in this population.     

Sleep problems in Parkinson¿s disease: a community-based study in Norway

ABSTRACT: BACKGROUND: The purpose of this study was to examine the prevalence of sleep problems in a community-based sample of patients with Parkinson's disease (PD) in Norway, and their associated factors. METHODS: 176 consecutive PD outpatients (41% females) were included in a study of non-motor symptoms, including sleep problems. All participants responded to the Parkinson's Disease Sleep Scale (PDSS), where an overall score below 82 or a score below 5 on a sub-item indicate possible sleep problem. Factors associated with sleep were also investigated, with special emphasis on severity of PD, fatigue, mental health and restless legs syndrome (RLS). RESULTS: The mean age was 68.5 years (range 35--90); the mean Hoehn and Yahr stage was 2.11 (SD 0.86), and the mean UPDRS part III was 22.3 (SD 11.7). Sleep problems were common among PD patients. While only 17% of the sample had an overall score below 82 on the PDSS, 70% of the patients had a score below 5 on one item. There was no significant association between PD severity and any of the sleep items in the PDSS; whereas fatigue, mental health problems, and RLS were associated with PDSS score. CONCLUSIONS: The current findings call for increased awareness of sleep problems in PD patients, especially focusing on the association with mental health problems, fatigue and RLS.     

Relationship between Motor Symptoms,Cognition, and Demographic Characteristics in Treated Mild/Moderate Parkinson’s Disease

Background

Although Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized primarily by motor symptoms, PD patients, at all stages of the disease, can experience cognitive dysfunction. However, the relationships between cognitive and motor symptoms and specific demographic characteristics are not well defined, particularly for patients who have progressed to requiring dopaminergic medication.

Objective

To examine relationships between motor and cognitive symptoms and various demographic factors in mild to moderate, PD patients requiring anti-PD medication.

Methods

Cognitive function was assessed in 94 subjects with a variety of neuropsychological tests during baseline evaluations as part of an experimental treatment study. Data were analyzed in relation to Unified Parkinson’s Disease Rating Scale motor scores and demographic variables.

Results

Of the UPDRS subscores analyzed, posture/balance/gait was associated with the highest number of adverse cognitive outcomes followed by speech/facial expression, bradykinesia, and rigidity. No associations were detected between any of the cognitive performance measures and tremor. Motor functioning assessed in the “off” condition correlated primarily with disease duration; neuropsychological performance in general was primarily related to age.

Conclusion

In PD patients who have advanced to requiring anti-PD therapies, there are salient associations between axial signs and cognitive performance and in particular, with different aspects of visuospatial function suggesting involvement of similar circuits in these functions. Associations between executive functions and bradykinesia also suggest involvement similar circuits in these functions.     

Hip Fracture in the Elderly: A Re-Analysis of the EPIDOS Study with Causal Bayesian Networks

Objectives

Hip fractures commonly result in permanent disability, institutionalization or death in elderly. Existing hip-fracture predicting tools are underused in clinical practice, partly due to their lack of intuitive interpretation. By use of a graphical layer, Bayesian network models could increase the attractiveness of fracture prediction tools. Our aim was to study the potential contribution of a causal Bayesian network in this clinical setting. A logistic regression was performed as a standard control approach to check the robustness of the causal Bayesian network approach.

Setting

EPIDOS is a multicenter study, conducted in an ambulatory care setting in five French cities between 1992 and 1996 and updated in 2010. The study included 7598 women aged 75 years or older, in which fractures were assessed quarterly during 4 years. A causal Bayesian network and a logistic regression were performed on EPIDOS data to describe major variables involved in hip fractures occurrences.

Results

Both models had similar association estimations and predictive performances. They detected gait speed and mineral bone density as variables the most involved in the fracture process. The causal Bayesian network showed that gait speed and bone mineral density were directly connected to fracture and seem to mediate the influence of all the other variables included in our model. The logistic regression approach detected multiple interactions involving psychotropic drug use, age and bone mineral density.

Conclusion

Both approaches retrieved similar variables as predictors of hip fractures. However, Bayesian network highlighted the whole web of relation between the variables involved in the analysis, suggesting a possible mechanism leading to hip fracture. According to the latter results, intervention focusing concomitantly on gait speed and bone mineral density may be necessary for an optimal prevention of hip fracture occurrence in elderly people.     

Novel parameters of surface EMG in patients with Parkinson’s disease and healthy young and old controls

The aim of this study was to evaluate a variety of traditional and novel surface electromyography (SEMG) characteristics of biceps brachii muscle in patients with Parkinson’s disease (PD) and compare the results with the healthy old and young control subjects. Furthermore, the aim was to define the optimal biceps brachii loading level that would most likely differentiate patients from controls. The results indicated that such nonlinear SEMG parameters as %Recurrence, %Determinism and SEMG distribution kurtosis, correlation dimension and sample entropy were significantly different between the PD patients and healthy controls. These novel nonlinear parameters, unlike traditional spectral or amplitude parameters, correlated with the Unified Parkinson’s Disease Rating Scale (UPDRS) and finger tapping scores. The most significant between group differences were found in the loading condition where no additional weights were applied in isometric elbow flexion. No major difference of SEMG characteristics was detected between old and young control subjects. In conclusion, the novel SEMG parameters can differentiate the patients with PD from healthy control subjects and these parameters may have potential in the assessment of the severity of PD.     

Functional foot symmetry and its relation to lower extremity physical performance in older adults: the Framingham Foot Study

BackgroundWhile many studies use gait symmetry as a marker of healthy gait, the evidence that gait symmetry exists is limited. Because gait symmetry is thought to arise through laterality (i.e., limb preference) and affects gait retraining efforts, it is important to understand if symmetry exists during gait in older adults. Therefore, the purpose of this study was to evaluate foot and gait symmetry in the population-based Framingham Foot Study as well as to determine the effects of vertical force symmetry on physical performance measures.MethodsMembers of the Framingham Foot Study were included in this analysis (N=1333). Foot function and force data were collected using the Tekscan Matscan during self-selected gait, with symmetry evaluated using the symmetry index. The short physical performance battery (SPPB) measures of balance, chair stands and gait speed assessed lower extremity physical function. Participants were evaluated using quartiles of gait speed and foot symmetry to determine the effects of symmetry on lower extremity physical function.ResultsIndividuals with faster gait speed displayed greater foot function asymmetry; individuals with ?3.0% to ?9.5% asymmetry in foot function performed better on the short physical performance battery (SPPB). Further, with aging, the degree of asymmetry was reduced.ConclusionsWhile this research suggests that a moderate degree of foot asymmetry is associated with better lower extremity function, the causes of vertical force asymmetry are unknown. Future studies should evaluate the causes of foot asymmetry and should track the changes in symmetry that occur with aging.     

Persons with multiple sclerosis show altered joint kinetics during walking after participating in elliptical exercise

Patients with multiple sclerosis (MS) experience abnormal gait patterns and reduced physical activity. The purpose of this study was to determine if an elliptical exercise intervention for patients with MS would change joint kinetics during gait toward healthy control values. Gait analysis was performed on patients with MS (n = 24) before and after completion of 15 sessions of supervised exercise. Joint torques and powers were calculated, while also using walking velocity as a covariate, to determine the effects of elliptical exercise on lower extremity joint kinetics during gait. Results show that elliptical exercise significantly altered joint torques at the ankle and hip and joint powers at the ankle during stance. The change in joint power at the ankle indicates that, after training, patients with MS employed a walking strategy that is more similar to that of healthy young adults. These results support the use of elliptical exercise as a gait training tool for patients with MS.     

Sagittal plane hip motion reversals during walking are associated with disease severity and poorer function in subjects with hip osteoarthritis

A midstance reversal of sagittal plane hip motion during walking, or motion discontinuity (MD), has previously been observed in subjects with endstage hip osteoarthritis (OA) and in patients with femoroacetabular impingement. The goal of the present study was to evaluate whether this gait pattern is a marker of OA presence or radiographic severity by analyzing a large IRB approved motion analysis data repository. We also hypothesized that subjects with the MD would show more substantial gait impairments than those with normal hip motion. We identified 150 subjects with symptomatic unilateral hip OA and Kellgren-Lawrence OA severity data on file, and a control group of 159 asymptomatic subjects whose ages fell within 2 standard deviations of the mean OA group age. From the gait data, the MD was defined as a reversal in the slope of the hip flexion angle curve during midstance. Logistic regressions and general linear models were used to test the association between the MD and OA presence, OA severity and, other gait variables. 53% of OA subjects compared to 7.5% of controls had the MD (p<0.001); occurrence of the MD was associated with OA severity (p=0.009). Within the OA subject group, subjects with the MD had reduced dynamic range of motion, peak, extension, and internal rotation moments compared to those who did not (MANCOVA p ≤ 0.042) after controlling for walking speed. We concluded that sagittal plane motion reversals are indeed associated with OA presence and severity, and with more severe gait abnormalities in subjects with hip OA.     

The effect of a 12-week combined exercise intervention program on physical performance and gait kinematics in community-dwelling elderly women

This study aimed to determine if combined exercise intervention improves physical performance and gait joint-kinematics including the joint angle and dynamic range of motion (ROM) related to the risk of falling in community-dwelling elderly women. A 12-week combined exercise intervention program with extra emphasis on balance, muscle strength, and walking ability was designed to improve physical performance and gait. Twenty participants attended approximately two-hour exercise sessions twice weekly for 12 weeks. Participants underwent a physical performance battery, including static balance, sit and reach, whole body reaction time, 10 m obstacle walk, 10 m maximal walk, 30-second chair stand, to determine a physical performance score, and received quantitative gait kinematics measurements at baseline and in 12 weeks. Significant lower extremity strength improvement 13.5% (p<.001) was observed, which was accompanied by significant decreases in time of the 10 m obstacle walk (p<.05) and whole body reaction time (p<.001) in this study. However, no significant differences were seen for static balance and flexibility from baseline. For gait kinematics, in the mid-swing phase, knee and hip joint angle changed toward flexion (p<.01, p<.05, respectively). Ankle dynamic ROM significantly increased (p<.05) following exercise intervention. The plantar flexion angle of the ankle in the toe-off phase was increased significantly (p<.01). However, other gait parameters were not significantly different from baseline. These findings from the present investigation provide evidence of significant improvements in physical performance related to the risk factors of falling and safe gait strategy with a combined exercise intervention program in community-dwelling elderly women. The results suggest this exercise intervention could be an effective approach to ameliorate the risk factors for falls and to promote safer locomotion in elderly community-dwelling women.     

Validity of time series kinematical data as measured by a markerless motion capture system on a flatland for gait assessment

As a cost-effective, clinician-friendly gait assessment tool, the Kinect v2 sensor may be effective for assessing lower extremity joint kinematics. This study aims to examine the validity of time series kinematical data as measured by the Kinect v2 on a flatland for gait assessment. In this study, 51 healthy subjects walked on a flatland while kinematic data were extracted concurrently using the Kinect and Vicon systems. The kinematic outcomes comprised the hip and knee joint angles. Parallel translation of Kinect data obtained throughout the gait cycle was performed to minimize the differences between the Kinect and Vicon data. The ensemble curves of the hip and knee joint angles were compared to investigate whether the Kinect sensor can consistently and accurately assess lower extremity joint motion throughout the gait cycle. Relative consistency was assessed using Pearson correlation coefficients. Joint angles measured by the Kinect v2 followed the trend of the trajectories made by the Vicon data in both the hip and knee joints in the sagittal plane. The trajectories of the hip and knee joint angles in the frontal plane differed between the Kinect and Vicon data. We observed moderate to high correlation coefficients of 20%–60% of the gait cycle, and the largest difference between Kinect and Vicon data was 4.2°. Kinect v2 time series kinematical data obtained on the flatland are validated if the appropriate correction procedures are performed. Future studies are warranted to examine the reproducibility and systematic bias of the Kinect v2.     

Implications of increased medio-lateral trunk sway for ambulatory mechanics

The purposes of this study was to test a mechanism to reduce the knee adduction moment by testing the hypothesis that increased medio-lateral trunk sway can reduce the knee adduction moment during ambulation in healthy subjects, and to examine the possibility that increasing medio-lateral trunk sway can produce similar potentially adverse secondary gait changes previously associated with reduced knee adduction moments in patients with knee osteoarthritis. Nineteen healthy adults performed walking trials with normal and increased medio-lateral trunk sway at a self-selected normal walking speed. Standard gait analysis was used to calculate three-dimensional lower extremity joint kinematics and kinetics. Knee and hip adduction moments were lower (-65.0% and -57.1%, respectively) for the increased medio-lateral trunk sway trials than for the normal trunk sway trials. Knee flexion angle at heel-strike was 3 degrees higher for the increased than for the normal trunk sway trials. Knee and hip abduction moments were higher for the increased medio-lateral trunk sway trials, and none of the other variables differed between the two conditions. Walking with increased medio-lateral trunk sway substantially reduces the knee adduction moment during walking in healthy subjects without some of the adverse secondary effects such as increased axial loading rates at the major joints of the lower extremity. This result supports the potential of using gait retraining for walking with increased medio-lateral trunk sway as treatment for patients with degenerative joint disease such as medial compartment knee osteoarthritis.     

Identification of passive elastic joint moment-angle relationships in the lower extremity

The purpose of this study was to develop a method for identifying subject-specific passive elastic joint moment-angle relationships in the lower extremity, which could subsequently be used to estimate passive contributions to joint kinetics during gait. Twenty healthy young adults participated in the study. Subjects were positioned side-lying with their dominant limb supported on a table via low-friction carts. A physical therapist slowly manipulated the limb through full sagittal hip, knee, and ankle ranges of motion using two hand-held 3D load cells. Lower extremity kinematics, measured with a passive marker motion capture system, and load cell readings were used to compute joint angles and associated passive joint moments. We formulated a passive joint moment-angle model that included eight exponential functions to account for forces generated via the passive stretch of uni-articular structures and bi-articular muscles. Model parameters were estimated for individual subjects by minimizing the sum of squared errors between model predicted and experimentally measured moments. The model predictions closely replicated measured joint moments with average root-mean-squared errors of 2.5, 1.4, and 0.7 Nm about the hip, knee, and ankle respectively. We show that the models can be coupled with gait kinematics to estimate passive joint moments during walking. Passive hip moments were substantial from terminal stance through initial swing, with energy being stored as the hip extended and subsequently returned during pre- and initial swing. We conclude that the proposed methodology could provide quantitative insights into the potentially important role that passive mechanisms play in both normal and abnormal gait.     

Apathy in Parkinson disease

Apathy is one of the least investigated symptom of Parkinson disease （PD）. In the article there are data of frequency, diagnostic features, pathophysiology and treatment of apathy in PD. The aim of the investigation was to evaluate the frequency of apathy in PD without dementia, evaluate the relationship with other neuropsychiatric and motor disorders, influence on the life quality. 115 patients （age-63.84±0.6 years, stage 2.6±0.3） with PD without dementia were included in the investigation. There were used the following scales： scale of evaluation stages of PD by Hoehn-Yahr, UPDRS （part 〈〈activity of daily living〉〉, 〈〈motor functions 〉〉）; Beck Depression Inventory, Spielberger State Trait Anxiety Inventory, Parkinson Disease Sleep Scale- PDSS, Epworth Sleepiness Scale, Parkinson Fatigue Scale-PFS- 16, SCOPA-Cog, Lilli Apathy Rating Scale LARS and Apathy Scale AS. Apathy was found in 25% of patients. The frequency and severity of apathy does not depend on stage and duration of PD. It was found positive correlation of apathy and hypokinesia. In different stages of PD there was variability of relationships of apathy with depression, executive functions and sleep disorders. We suppose the heterogeneity of apathy in PD because of the variability of the association with other neuropsychiatric （affective, cognitive, sleep） disorders. It was found the negative influence of apathy on daily activity, emotional and social aspects of life quality.     

Association between knee extensor force steadiness and postural stability against mechanical perturbation in patients with Parkinson’s disease

ObjectiveLower extremity force steadiness has been shown to decrease with aging and neuromotor dysfunction and to be associated with physical function and fall. Although patients with Parkinson’s disease (PD) experience decreased force steadiness, whether the extent of force steadiness differs according to target force or whether this steadiness is associated with postural control remain unclear. Therefore, this study aimed to compare the force steadiness while steadily exerting low and moderate levels of knee extensor force between individuals with and without PD and to examine the association between force steadiness and postural instability against mechanical perturbation in PD.MethodsA total of 33 patients with PD (mean age, 71.7 years) and 33 healthy controls (72.2 years) participated in this study. Participants with PD were classified into postural stability or instability groups based on the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale motor exam item 12. Participants performed steady task of the knee isometric extension at two levels (10% and 50% of maximal voluntary contraction [MVC]).ResultsForce steadiness at 10% MVC was lower in postural instability group than that in the control and postural stability groups (P < 0.05) after adjusting for age, sex, and body mass index, whereas it was not significantly different at 50% MVC among the three groups.DiscussionThese results suggest that the knee extensor force steadiness is affected in patients with PD having postural instability against mechanical perturbation during low intensity force exertion and is not affected regardless of the presence of postural instability during moderate intensity force exertion.     

α-Synuclein genetic variants predict faster motor symptom progression in idiopathic Parkinson disease

Currently, there are no reported genetic predictors of motor symptom progression in Parkinson's disease (PD). In familial PD, disease severity is associated with higher α-synuclein (SNCA) expression levels, and in postmortem studies expression varies with SNCA genetic variants. Furthermore, SNCA is a well-known risk factor for PD occurrence. We recruited Parkinson's patients from the communities of three central California counties to investigate the influence of SNCA genetic variants on motor symptom progression in idiopathic PD. We repeatedly assessed this cohort of patients over an average of 5.1 years for motor symptom changes employing the Unified Parkinson's Disease Rating Scale (UPDRS). Of 363 population-based incident PD cases diagnosed less than 3 years from baseline assessment, 242 cases were successfully re-contacted and 233 were re-examined at least once. Of subjects lost to follow-up, 69% were due to death. Adjusting for covariates, risk of faster decline of motor function as measured by annual increase in motor UPDRS exam score was increased 4-fold in carriers of the REP1 263bp promoter variant (OR 4.03, 95%CI:1.57-10.4). Our data also suggest a contribution to increased risk by the G-allele for rs356165 (OR 1.66; 95%CI:0.96-2.88), and we observed a strong trend across categories when both genetic variants were considered (p for trend = 0.002). Our population-based study has demonstrated that SNCA variants are strong predictors of faster motor decline in idiopathic PD. SNCA may be a promising target for therapies and may help identify patients who will benefit most from early interventions. This is the first study to link SNCA to motor symptom decline in a longitudinal progression study.