International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: The NMSQuest study

Baylor College of Medicine, Houston, Texas, United States
Movement Disorders (Impact Factor: 5.63). 07/2006; 21(7):916-23. DOI: 10.1002/mds.20844
Source: PubMed

ABSTRACT Nonmotor symptoms (NMS) of Parkinson's disease (PD) are not well recognized in clinical practice, either in primary or in secondary care, and are frequently missed during routine consultations. There is no single instrument (questionnaire or scale) that enables a comprehensive assessment of the range of NMS in PD both for the identification of problems and for the measurement of outcome. Against this background, a multidisciplinary group of experts, including patient group representatives, has developed an NMS screening questionnaire comprising 30 items. This instrument does not provide an overall score of disability and is not a graded or rating instrument. Instead, it is a screening tool designed to draw attention to the presence of NMS and initiate further investigation. In this article, we present the results from an international pilot study assessing feasibility, validity, and acceptability of a nonmotor questionnaire (NMSQuest). Data from 123 PD patients and 96 controls were analyzed. NMS were highly significantly more prevalent in PD compared to controls (PD NMS, median = 9.0, mean = 9.5 vs. control NMS, median = 5.5, mean = 4.0; Mann-Whitney, Kruskal-Wallis, and t test, P < 0.0001), with PD patients reporting at least 10 different NMS on average per patient. In PD, NMS were highly significantly more prevalent across all disease stages and the number of symptoms correlated significantly with advancing disease and duration of disease. Furthermore, frequently, problems such as diplopia, dribbling, apathy, blues, taste and smell problems were never previously disclosed to the health professionals.

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Available from: Kallol Ray Chaudhuri, Sep 04, 2015
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    • "NA Note. PD ON ϭ patients with Parkinson's disease on medication; HCϭ healthy controls; SF-36 ϭ 36-Item Short-Form Health Survey (Ware & Sherbourne, 1992); PCS ϭ SF-36-Physical Component Summary; MCS ϭ SF-36-Mental Component Summary; BDI ϭ Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961); BIS-11 ϭ Barratt Impulsiveness Scale-11 (Patton, Stanford, & Barratt, 1995); UPDRS ϭ Unified Parkinson's Disease Rating Scale (Fahn & Elton, 1987); NA ϭ not applicable; NMS-PD ϭ Nonmotor Symptoms Questionnaire for Parkinson's Disease (Chaudhuri et al., 2006 "
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    ABSTRACT: Objective: The study was designed to examine persistent (input selection) versus transient (input shifting) mechanisms of attention control in Parkinson's disease (PD). Method: The study identifies behavioral and neural markers of selective control and shifting control using a novel combination of a flanker task with an attentional set-shifting task, and it compares patients with PD with matched controls. Event-related brain potentials (ERPs) were recorded, and analyses focused on frontally distributed N2 waves, parietally distributed P3 waves, and error-related negativities (Ne/ERN). Results: Controls showed robust shifting costs (prolonged response times), but patients with PD did not show evidence for comparable shifting costs. Patients with PD made more errors than controls when required to shift between attentional sets, but also when they had to initially maintain an attentional set. At the neural level it was found that contrary to controls, patients with PD did not display any N2 and P3 augmentations on shift trials. Patients with PD further did not display any error-related activity or posterror N2 augmentation. Conclusions: Our results reveal that intact selective control and disrupted shifting control are dissociable in patients with PD, but additional work is required to dissect the proportionate effects of disease and treatment on shifting control in PD. Our ERP-based approach opens a new window onto an understanding of motor and cognitive flexibility that seems to be associated with the dopaminergic innervation of cortico-striatal loops. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Neuropsychology 11/2014; DOI:10.1037/neu0000099 · 3.43 Impact Factor
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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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    • "All patients provided written informed consent. The patients were interviewed for clinical history, evaluated with the NMSQuest,11 answered a 30-item self-administered questionnaire evaluating NMS, and scored for motor symptoms (Unified Parkinson's Disease Rating Scale [UPDRS]-III). A diagnosis of PD or ET was made by neurologists who were not involved in this study, and were made on the basis of the clinical and instrumental data (imaging and [123I] β-CIT SPECT). "
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    ABSTRACT: Non-motor symptoms (NMS) in Parkinson's disease (PD) differ from those in essential tremor (ET), even before a definitive diagnosis is made. It is not clear whether patient's knowledge of the diagnosis and treatment influence their subsequent reporting of NMS. 1 year after a clinical and instrumental diagnosis, we compared the motor impairment (Movement Disorders Society (MDS)-Unified Parkinson's Disease Rating Scale-III) and non-motor symptoms (NMSQuest) in PD (n = 31) and ET (n = 21) patients. PD patients reported more NMS than did the ET patients (p = 0.002). When compared to their baseline report, at follow-up, PD patients reported less nocturia (p = 0.02), sadness (p = 0.01), insomnia (p = 0.02), and restless legs (p = 0.04) and more nausea (p = 0.024), unexplained pain (p = 0.03), weight change (p = 0.009), and daytime sleepiness (p = 0.03). When compared to their baseline report, ET patients reported less loss of interest (p = 0.03), anxiety (p = 0.006), and insomnia (p = 0.02). Differences in reported weight change (p<0.0001) and anxiety (p = 0.001) between PD and ET patients were related to pharmacological side effects or to a reduction in the ET individuals. The reporting of NMS is influenced by subjective factors, and might vary with the patient's knowledge of the diagnosis or the effectiveness of treatment.
    04/2014; 4:216. DOI:10.7916/D82J68TH
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