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: 8.29). 01/2013; 80(3):276-81. DOI: 10.1212/WNL.0b013e31827deb74
Source: PubMed


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 · 1.91 Impact Factor
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    • "Recent studies have shown that many patients experience a wide range of non-motor symptoms (NMS) such as mood disorders, loss of sense of smell, and constipation [6]. Approximately 21% of PD patients having non-motor features [6], which occur due to the continuous loss of dopaminergic cells located in the substantia nigra pars compacta [2]. This loss becomes drastic when around 80% of the striatal dopamine and about 50% of nigral neurons are lost [7]. "
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    ABSTRACT: Background Parkinson’s disease (PD) continues to be an important neurological disorder. It is caused by the loss of dopaminergic neurons in the substantia nigra. Dopamine, the neurotransmitter produced from dopaminergic neurons, is a major precursor of endogenous morphine. There are approximately 18 genes associated with PD; their roles have not yet been completely established. PARK2 is a gene that encodes for the protein parkin, and PINK1 is a gene that encodes for PTEN-induced putative kinase 1. Material/Methods Our objective was to determine if morphine treatment of HTB-11 cells affects the expression of PINK1 and PARK2. HTB-11 cells were treated with 10−7 M morphine for 2 h and a microarray analysis was conducted. To verify the microarray analysis, 3 Q-PCR trials were run using 10−6 M naloxone, morphine (10−7 M), or a naloxone/morphine mix. Results In both the microarray analysis and the Q-PCR analysis, PARK2 was up-regulated and PINK1 was down-regulated. Conclusions Morphine can affect the expression of PD-associated genes.
    05/2014; 20:63-9. DOI:10.12659/MSMBR.890557
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