Opinion
Video
Movement Scores and Beyond: Patient-Reported Outcomes in Tardive Dyskinesia Management
Panelists discuss how the use of both clinician- and patient-reported scales—such as the Impact TD scale, TDIS, and Impact TD Pro—enhances understanding of tardive dyskinesia’s true impact on daily functioning and quality of life, emphasizing the importance of incorporating patient perspectives to guide early, personalized treatment strategies that improve physical symptoms and overall well-being.
There are 2 primary scales used to assess the impact of tardive dyskinesia (TD): the Impact TD scale and the Tardive Dyskinesia Identification Scale (TDIS). The Impact TD scale is primarily clinician-scored with some caregiver and patient input, while the TDIS is entirely patient-reported. Recently, a patient-rated version called Impact TD Pro has emerged, reflecting a shift toward including the patient’s own perspective in research and treatment evaluation. This patient-focused approach helps capture how TD affects daily physical functioning—such as pain, difficulty chewing or swallowing, walking, or engaging in activities—and emotional well-being, providing a fuller picture beyond what clinicians observe during brief assessments.
In clinical studies, such as AIMS and CONNECT-TD, these scales have shown that symptom severity does not always align with the degree of impact on quality of life. Some individuals with mild symptoms report a significant negative effect on their daily lives, highlighting the importance of evaluating the patient’s subjective experience. Treatment with VMAT2 inhibitors has demonstrated improvements not only in the physical symptoms but also in patients’ ability to engage socially and function more independently. For example, some patients report feeling comfortable going out to run errands or socialize, activities they might have avoided previously due to embarrassment or discomfort caused by their movements.
The evolving research underscores the need to prioritize patient-reported outcomes when deciding on treatment strategies. Since TD progression is unpredictable, and even mild symptoms can greatly affect quality of life, early intervention should be considered. This perspective encourages health care providers to look beyond objective severity ratings and engage patients in conversations about how their symptoms impact their everyday life, ultimately aiming for treatments that improve both physical symptoms and overall well-being.
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