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
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    ABSTRACT: Nonmotor symptoms (NMS) fluctuate in conjunction with motor oscillations in advanced Parkinson's disease (PD), though little is known about the variability of NMS fluctuations in individual patients. We aimed to assess within-patient variability in frequency and severity of NMS during a series of five patient-perceived motor On and Off periods in 38 fluctuating PD patients from the multicenter NonMotorFluctuations in PD study using a visual analogue scale. NMS frequency and severity appeared moderately variable in both motor states within individual patients. Symptom severity ranges between motor states showed high variability and were larger in motor Off states for most NMS.
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    • "able having the strongest association with HRQoL . In case no rank order could be made ( e . g . due to incomplete presentation of statistical results ( Bach et al . , 2012 ; Ellis et al . , 2011 ; Kleiner - Fisman et al . , 2010 ; Lee et al . , 2006 ; Martinez - Martin et al . , 2006 ; Rodriguez - Violante et al . , 2013 ; Slawek et al . , 2005 ; Storch et al . , 2013 ) ) , all features significantly associated with the HRQoL instrument received a β of 0 . 5 which equals an α of 0 . 75 ( see below ) . If more than one HRQoL questionnaire was used in an article , the quality score was divided by the number of included HRQoL questionnaires . This was done so that features from the same study would not "
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