SEARCHNARRATIVE_REVIEWneurology, ophthalmology

narrative_review·neurology, ophthalmology, gastroenterology, nutrition, public health·PMC10248458

Chaudhuri's Dashboard of Vitals in Parkinson's syndrome: an unmet need underpinned by real life clinical tests

Frontiers in Neurology · 15 authors, 14 centres

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This narrative review introduces the 'Chaudhuri's Dashboard of Vitals in Parkinson's,' a framework that expands routine clinical assessment beyond motor and nonmotor symptoms to include visual, gut, oral health, bone health, and comorbidities. The authors argue that these often-neglected vitals are critical for holistic care and patient safety, and they catalog available and emerging clinical tests for each domain. The clinical significance lies in promoting a more comprehensive, personalized approach to managing Parkinson's disease to improve quality of life and outcomes.

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**Background** Parkinson's disease (PD) is a progressive neurodegenerative condition with rising global incidence. Modern concepts extend beyond motor symptoms to include nonmotor symptoms (NMS) and overall wellness. The authors propose a 'Dashboard of Vitals in Parkinson's' comprising five domains: motor, nonmotor, visual/gut/oral health, bone health/falls, and comorbidities/comedications/dopamine agonist side effects. They highlight that vitals 3–5 are frequently overlooked in clinical practice, leading to poor levodopa absorption, fractures, and dangerous daytime sleepiness.

**Methods** This is a narrative review based on the authors' clinical experience across sites in the U.K., U.A.E., and Romania, supplemented by literature on clinical tests for each vital. The review categorizes tools into those currently available, potentially available, and those for future consideration. It also includes clinical scales and questionnaires.

**Key Results** - **Motor vital**: DaTScan correlates with motor subtypes (more reduced in akinetic-rigid and PIGD vs. tremor-dominant) and disease progression. Brain MRI sequences (neuromelanin, SWI, diffusion imaging) and transcranial sonography of substantia nigra are promising but investigational. Blood-based markers (NfL, alpha-synuclein) correlate with motor severity. Wearable technology provides objective monitoring but lacks standardization. - **Nonmotor vital**: MIBG scintigraphy evaluates cardiac autonomic denervation. Serum uric acid shows inverse association with NMS burden, but data are conflicting. Serum homocysteine and CRP are elevated in severe subtypes, but levodopa increases homocysteine. CSF biomarkers (Aβ1-42, α-synuclein, NfL) predict NMS progression. Wearable technology and computerized cognitive batteries aid assessment. - **Visual, gut, and oral health**: Visual abnormalities (78–82% prevalence) include contrast sensitivity loss, color discrimination deficits, dry eyes, and oculomotor disturbances. OCT shows retinal nerve fiber layer thinning and macular volume reduction. ERG and VEP detect early dysfunction. Corneal confocal microscopy reveals small nerve fiber pathology. Tear film tests and tear alpha-synuclein are emerging. Gut health involves dysphagia, constipation, Helicobacter pylori infection (increased prevalence in PD), and small intestinal bacterial overgrowth (SIBO). Diagnostic tools include VFSS, FEES, abdominal XR/CT, urea breath test, stool antigen test, and hydrogen breath test. Oral health issues include periodontitis, sialorrhea, and Porphyromonas gingivalis. Systemic inflammatory markers (CRP, IL-1, TNF-alpha) and salivary tests are under investigation. - **Bone health and falls**: Osteoporosis prevalence is 91% in women and 61% in men with PD. DEXA is recommended for patients over 50. Serum 25-OH-vitamin D correlates with BMD. FRAX tool may need adjustment for PD. Wearable sensors detect balance issues and predict falls. - **Comorbidities, comedications, and dopamine agonist side effects**: Diabetes is associated with faster motor progression (HbA1c >45 mmol/mol predicts quicker progression). Weight loss is common and linked to faster cognitive decline. Blood pressure fluctuations are assessed with 24-h ambulatory monitoring. Co-morbidities Polypharmacy Score and anticholinergic burden scales (ADS, DBI-ACh) are useful. ICDs and excessive daytime sleepiness are dopamine agonist side effects; EEG and MSLT are potential tools.

**Clinical Implications** The Dashboard of Vitals provides a structured framework for holistic PD care. Currently, only motor and nonmotor vitals are widely assessed. Incorporating visual, gut, oral, bone, and comorbidity assessments can improve quality of life, prevent complications (e.g., fractures, aspiration, poor drug absorption), and enable personalized medicine. Many tests are already available (e.g., OCT, DEXA, VFSS, HbA1c), while others require further validation and cost-effectiveness analysis. The authors urge clinicians to adopt this comprehensive approach to address unmet needs in PD management.

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narrative_review

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neurology

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ORIGINAL PAPER

PMC10248458

Chaudhuri's Dashboard of Vitals in Parkinson's syndrome: an unmet need underpinned by real life clinical tests

Frontiers in Neurology

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ABSTRACT

Abstract We have recently published the notion of the “vitals” of Parkinson’s, a conglomeration of signs and symptoms, largely nonmotor, that must not be missed and yet often not considered in neurological consultations, with considerable societal and personal detrimental consequences. This “dashboard,” termed the Chaudhuri’s vitals of Parkinson’s, are summarized as 5 key vital symptoms or signs and comprise of (a) motor, (b) nonmotor, (c) visual, gut, and oral health, (d) bone health and falls, and finally (e) comorbidities, comedication, and dopamine agonist side effects, such as impulse control disorders. Additionally, not addressing the vitals also may reflect inadequate management strategies, leading to worsening quality of life and diminished wellness, a new concept for people with Parkinson’s. In this paper, we discuss possible, simple to use, and clinically relevant tests that can be used to monitor the status of these vitals, so that these can be incorporated into clinical practice. We also use the term Parkinson’s syndrome to describe Parkinson’s disease, as the term “disease” is now abandoned in many countries, such as the U.K., reflecting the heterogeneity of Parkinson’s, which is now considered by many as a syndrome. Keywords: Parkinson’s disease, motor, nonmotor, vitals, dashboard, oral, gut, vision

CITATION EXPORT

Mubasher A Qamar, Silvia Rota, Lucia Batzu et al.. Chaudhuri’s Dashboard of Vitals in Parkinson’s syndrome: an unmet need underpinned by real life clinical tests. Frontiers in Neurology. (2023). https://doi.org/10.3389/fneur.2023.1174698

AUTHORS

15 · 14 CENTRES

Mubasher A Qamar, Silvia Rota, Lucia Batzu, Indu Subramanian, Cristian Falup-Pecurariu, Nataliya Titova, Vinod Metta, Iulia Murasan, Per Odin, Chandrasekhara Padmakumar, Prashanth L Kukkle, Rupam Borgohain, Rukmini Mridula Kandadai, Vinay Goyal, Kallol Ray Chaudhuri

1Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
2King’s College Hospital NHS Foundation Trust, London, United Kingdom
3Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
4Parkinson’s Disease Research, Education and Clinical Centers, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, United States
5Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
6Department of Neurology, County Clinic Hospital, Brașov, Romania
7Department of Neurology, Neurosurgery and Medical Genetics, Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation, Moscow, Russia
8Department of Neurodegenerative Diseases, Federal State Budgetary Institution “Federal Center of Brain Research and Neurotechnologies” of the Federal Medical Biological Agency, Moscow, Russia
9Department of Neurology, University Hospital, Lund, Sweden
10Older Person’s Medical Clinic, Broadmeadow, NSW, Australia
11Center for Parkinson’s Disease and Movement Disorders, Manipal Hospital, Karnataka, India, Bangalore
12Parkinson’s Disease and Movement Disorders Clinic, Bangalore, Karnataka, India
13Department of Neurology, Nizam’s Institute of Medical Sciences, Autonomous University, Hyderabad, India
14Neurology Department, Medanta, Gurugram, India