The spectrum of nonmotor symptoms in early Parkinson disease

and Cambridge Centre for Brain Repair (R.A.B.), Cambridge University, Cambridge, UK.
Neurology (Impact Factor: 8.3). 01/2013; 80(3):276-81. DOI: 10.1212/WNL.0b013e31827deb74
Source: PubMed

ABSTRACT Nonmotor symptoms (NMS) are common in patients with established Parkinson disease (PD) but their frequency in early PD has not been extensively studied. Our aim was to determine the frequency of NMS in a cohort of patients with newly diagnosed PD.
A total of 159 patients with early PD and 99 healthy controls participated in this study. NMS were screened for using the Nonmotor Symptom Questionnaire. Other assessments included measures of motor disability (Movement Disorders Society-revised Unified Parkinson's Disease Rating Scale [MDS-UPDRS]), disease severity (Hoehn & Yahr staging), depression (Geriatric Depression Scale), and global cognitive function (Mini-Mental State Examination and Montreal Cognitive Assessment).
The PD group reported a significantly greater number of NMS compared with controls (8.4 [4.3] vs 2.8 [2.6]). In the PD group, the most commonly experienced NMS were excessive saliva, forgetfulness, urinary urgency, hyposmia, and constipation. Patients with higher MDS-UPDRS III scores and those with the postural instability gait subtype experienced a greater number of NMS.
NMS are common in early PD and reflect the multisystem nature of the disorder. Even in the earliest stages of PD, NMS may be detrimental to patients' functional status and sense of well-being.

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    • "of Cognitive Impairment in Cohorts with Longitudinal Evaluation—Parkinson's disease) conducted between June 2009 and December 2011 [29] "
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    ABSTRACT: Measurement of gait is becoming important as a tool to identify disease and disease progression, yet to date its application is limited largely to specialist centres. Wearable devices enables gait to be measured in naturalistic environments however questions remain regarding validity. Previous research suggests that when compared with a laboratory reference, measurement accuracy is acceptable for mean but not variability or asymmetry gait characteristics. Some fundamental reasons for this have been presented (e.g. synchronisation, different sampling frequencies) but to date this has not been systematically examined. The aims of this study were to: (i) quantify a comprehensive range of gait characteristics measured using a single tri-axial accelerometer-based monitor, (ii) examine outcomes and monitor performance in measuring gait in older adults and those with Parkinson's disease (PD) and (iii) carry out a detailed comparison with those derived from an instrumented walkway to account for any discrepancies. Fourteen gait characteristics were quantified in 30 people with incident PD and 30 healthy age-matched controls. Of the 14 gait characteristics compared, agreement between instruments was excellent for 4 (ICCs 0.913 - 0.983); moderate for 4 (ICCs 0.508 - 0.766); and poor for 6 characteristics (ICCs -0.637 - 0.370). Further analysis revealed that differences reflect an increased sensitivity of accelerometry to detect motion, rather than measurement error. This is most likely because accelerometry measures gait as a continuous activity rather than discrete footfall events, per instrumented tools. The increased sensitivity shown for these characteristics will be of particular interest to researchers keen to interpret 'real world' gait data. In conclusion, use of a body worn monitor is recommended for the measurement of gait but is likely to yield more sensitive data for asymmetry and variability features.
    04/2015; DOI:10.1109/JBHI.2015.2419317
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    • "However, the fact that NMS may arise as part of drug related effects and side effects confounds this issue further. Recently, the importance of measuring NMS using validated tools, such as the NMS Questionnaire (NMSQuest) [6] and the NMS Scale (NMSS) [7] has been described in two independent case control studies in drug na¨ıve PD [8] and early PD [9] patients. "
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    ABSTRACT: Background: Recent studies have demonstrated that, contrary to common perception non-motor symptoms (NMS) occur and may dominate early and untreated stage of Parkinson's disease (PD). Objective: The aim of this ongoing study was to describe the overall NMS profile and burden in drug naïve PD patients (DNPD) compared to a group of long-term PD patients (LTPD, disease duration ≥15 years). Methods: Cross sectional UK data from a multicenter (16 sites) collaboration were obtained and specifically NMS dataset from validated scales were analysed in DNPD and LTPD patients. The NMS scale (NMSS) was used as the primary outcome variable. Results: Out of a current database of 468 PD patients, 57 were DNPD (58% males, mean age 64.8 years, median Hoen and Yahr stage 1) and 25 were LTPD (44%, mean age 67.6 years, median Hoen and Yahr stage 3). DNPD patients had a significantly lower (p = 0.001) NMSS score (mean 45.5, range 1-150) compared to the LTPD patients (mean 74.0, range 6-155), but 26.3% had severe and 19.3% had very severe burden of NMSS using NMSS cutoff scores. In comparison, 20.0% of the LTPD patients had severe and 60.0% very severe burden of NMS (p = 0.003). Conclusions: NMS are common in DNPD patients and over 45% may have severe to very severe burden of NMS, which is a key determinant of quality of life. In LTPD patients not only the burden of "very severe" NMS is significantly higher, but there are also differences in the profile of expression of NMS.
    Journal of Parkinson's Disease 06/2014; 4(3). DOI:10.3233/JPD-140372 · 1.10 Impact Factor
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    • "from more than one population-based or cohort study ? Evidence from one population-based or cohort study ± No evidence from population-based or cohort studies, but respective non-motor symptom is frequently seen in early PD (Erro et al. 2013; Khoo et al. 2013; Barone et al. 2009) RBD rapid eye movement sleep behavior disorder, PLMS periodic limb movements during sleep, RLS restless legs syndrome Need to redefine Parkinson's disease REM sleep behavior disorder RBD is a parasomnia clinically characterized by dreamenacting behaviors related to loss of physiological atonia during REM sleep (Schenck et al. 1986). The prevalence of ''idiopathic'' RBD in the population is not well defined and a commonly cited figure of 0.4 % may well be an underestimate (Gagnon et al. 2006). "
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    ABSTRACT: Parkinson's disease (PD) is classically defined by its cardinal motor features and current clinical diagnostic criteria require the presence of bradykinesia and at least one additional motor symptom out of tremor, rigidity or postural instability. However, converging evidence from clinical, neuropathological, imaging and genetic research suggests initiation of PD-specific pathology prior to appearance of classical motor signs. This is of particular relevance in relation to the development of disease-modifying or neuroprotective therapies which would require intervention at the earliest stages of disease. A key challenge in PD research, therefore, is to better characterize markers for the 'preclinical' stages of the illness. Development of PD criteria by combining such markers allowing for an early diagnosis and intervention could pave the way for the design and implementation of future disease modification trials.
    Journal of Neural Transmission 05/2013; 120(S1). DOI:10.1007/s00702-013-1038-5 · 2.87 Impact Factor
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