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To compare the capabilities of two clinical classification systems, motor-phenotypes, and a simplified clinical motor-nonmotor subtyping system, a cohort was included at mean 7.9\u2009\u00b1\u20095.3 years of disease duration, classified using both clinical systems, and reexamined and reclassified at the end of an observation period. Time-points were retrospectively extracted for five major disease milestones: death, dementia, Hoehn and Yahr stage 5, nursing home living, and walking aid use. Eighty-nine patients were observed for 8.1\u2009\u00b1\u20092.7 years after inclusion. Dementia developed in 32.9% of the patients and 36.0\u201367.4% reached the other milestones. Motor-phenotypes were unable to stratify risks during this period, but the worst compared with the more favorable groups in the motor-nonmotor system conveyed hazard ratios between 2.6 and 63.6 for all milestones. A clear separation of risks for dying, living at the nursing home, and reaching motor end-stage was also shown when using only postural instability and gait disorder symptoms, without weighing them against the severity of the tremor. At reexamination, 29.4% and 64.7% of patients had changed classification groups in the motor-phenotype and motor-nonmotor systems, respectively. The motor-nonmotor system thus stratified risks of reaching crucial outcomes in mid\u2013late Parkinson\u2019s disease far better than the well-studied motor-phenotypes. Removing the tremor aspect of motor-phenotypes clearly improved this system, however. Classifications in both systems became unstable over time. The simplification of the motor-nonmotor system was easily applicable and showed potential as a prognostic marker during a large part of Parkinson\u2019s disease.<\/jats:p>","DOI":"10.1038\/s41531-021-00208-4","type":"journal-article","created":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T10:04:43Z","timestamp":1627898683000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Clinical classification systems and long-term outcome in mid- and late-stage Parkinson\u2019s disease"],"prefix":"10.1038","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5267-3344","authenticated-orcid":false,"given":"Emil","family":"Ygland R\u00f6dstr\u00f6m","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3201-8198","authenticated-orcid":false,"given":"Andreas","family":"Puschmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,2]]},"reference":[{"key":"208_CR1","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1111\/ejn.14094","volume":"49","author":"JC Greenland","year":"2019","unstructured":"Greenland, J. 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