Nonmotor fluctuations in Parkinson disease Severity and correlation with motor complications

From the Department of Neurology, Division of Neurodegenerative Diseases (A.S., C.B.S., M.W., Y.S.), Department of Medical Informatics and Biometry (R.K.), and Department of Neurology (H.R.), Dresden University of Technology, Dresden
Neurology (Impact Factor: 8.29). 01/2013; 80(9). DOI: 10.1212/WNL.0b013e318285c0ed
Source: PubMed


To evaluate frequency, severity, and correlation of nonmotor symptoms (NMS) with motor complications in fluctuating Parkinson disease (PD).

The Multicenter NonMotor Fluctuations in PD cross-sectional study used clinical examination of 10 NMS (dysphagia, anxiety, depression, fatigue, excessive sweating, inner restlessness, pain, concentration/attention, dizziness, bladder urgency) quantified using a visual analogue scale (VAS) in motor-defined on (NMS(On)) and off state (NMS(Off)) combined with motor assessments and self-ratings at home in 100 patients with advanced PD.

All NMS except dysphagia, excessive sweating, and bladder urgency fluctuated in conjunction to motor fluctuations with more frequent and severe symptoms in off compared to on state. The proportions of patients experiencing autonomic/sensory NMS in both motor states were similar to those with these NMS exclusively in off state (ratios 0.4-1.3), while for mental/psychic NMS the proportions with exclusive manifestation in off state were higher (ratios 1.8-3.1). Demographic and clinical characteristics correlated neither with NMS frequency patterns and severities nor with ΔNMS(On/Off) severities (defined as the differences of VAS scores between on and off). Severities of NMS(on), NMS(Off), and ΔNMS(On/Off) did not correlate with motor function. Presence of anxiety, depression, fatigue, and pain had negative impact on health-related quality of life (HRQOL) measured by Parkinson's Disease Questionnaire-8 scoring independent of their occurrence with respect to motor state. Fluctuations of these NMS but not of fatigue deteriorated HRQOL.

Patterns of NMS fluctuations are heterogeneous and complex, but psychic NMS fluctuate more frequently and severely. Demographic parameters and motor function do not correlate with NMS or nonmotor fluctuation severities in fluctuating PD.

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Available from: Wolfgang H Jost, Jan 08, 2015
    • "The typical cardinal symptoms of Parkinson's disease (PD) are akinesia, rigidity, tremor and postural instability. The long-term course of the disease becomes complicated by motor and non-motor fluctuations and failing efficacy of the medication (Storch et al. 2013). Specific assessments and comprehensive tools are available for diagnostic and therapeutic use (Chaudhuri et al. 2007; Marras and Lang 2008; Olanow et al. 2009; Rascol et al. 2011; Sprenger and Poewe 2013). "
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    ABSTRACT: General medical problems and complications have a major impact on the quality of life in all stages of Parkinson's disease. To introduce an effective treatment, a comprehensive analysis of the various clinical symptoms must be undertaken. One must distinguish between (1) diseases which arise independently of Parkinson's disease, and (2) diseases which are a direct or indirect consequence of Parkinson's disease. Medical comorbidity may induce additional limitations to physical strength and coping strategies, and may thus restrict the efficacy of the physical therapy which is essential for treating hypokinetic-rigid symptoms. In selecting the appropriate medication for the treatment of any additional medical symptoms, which may arise, its limitations, contraindications and interactions with dopaminergic substances have to be taken into consideration. General medical symptoms and organ manifestations may also arise as a direct consequence of the autonomic dysfunction associated with Parkinson's disease. As the disease progresses, additional non-parkinsonian symptoms can be of concern. Furthermore, the side effects of Parkinson medications may necessitate the involvement of other medical specialists. In this review, we will discuss the various general medical aspects of Parkinson's disease.
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    • "Second, we did not perform a test–retest investigation and are thus not able to provide test–retest reliability data of the NMSS for the two motor states. The previous studies reported satisfactory stability of the NMSS (Chaudhuri et al. 2007; Storch et al. 2013). Third, we only had complete NMSS datasets from 73 % of patients. "
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    ABSTRACT: Data on frequency, severity and correlations of NMS with motor complications are only available for a limited number of NMS. The NMS Scale (NMSS) is a validated tool to assess a broad range of NMS, which has not been used in NMS fluctuations. We assessed fluctuations of a broad range of non-motor symptom (NMS) for a 1-month time period in fluctuating Parkinson's disease (PD) in a multicenter cross-sectional study using the NMSS assessing NMS in motor On (NMSSOn) and Off state (NMSSOff) combined with clinical NMS and motor function scoring in 100 fluctuating PD patients. ΔNMSSOn/Off was defined as the differences of NMSS scores between On and Off. Complete NMSS datasets were available from 73 patients (53 % men; age: 68.2 ± 9.7 years) with mean total NMSS score in On state of 41.5 ± 37.6 and in Off state of 75.6 ± 42.3 (P < 0.001). Scores were higher in Off compared to On state for all domains except for domain "perceptual problems/hallucinations" (P = 0.608). Clinimetric properties of the NMSS were similar to those reported previously for NMS assessments independent of motor oscillations. NMSSOn, NMSSOff and ΔNMSSOn/Off showed weak to moderate correlations with demographics, indicators of motor symptom severity as well as with other measures of NMS, depression and quality of life. Correlations of NMSS items/domains with independent measures of related constructs were weak to moderate. In conclusion, when assessed with the NMSS, a broad range of NMS fluctuate with motor oscillations, but these fluctuations do neither correlate with motor function nor with measures of disease progression.
    Journal of Neural Transmission 08/2015; 122(12). DOI:10.1007/s00702-015-1437-x · 2.40 Impact Factor
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    • "Cognitive decline, falls and gait problems such as freezing may counteract beneficial responses. However, cognitive issues such as clouding of consciousness, concentration impairment as a manifestation of non-motor fluctuation and freezing may occur during 'off' periods and should be treatable by device-aided therapies [13]. Cognitive assessment should be conducted ideally at 'on' and 'off' stages before initiating device-aided therapy, recognizing that even marked cognitive impairment may be a consequence of a patient's current treatment. "
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