Non-motor Parkinson’s disease symptoms show variable course

By Andrew Czyzewski

The non-motor symptoms (NMS) of patients with Parkinson's disease (PD) show a variable evolution that does not follow motor deterioration and is symptom specific, results of a 2-year follow-up study show.

Symptoms such as sleep and gastrointestinal disturbances became more prevalent and psychiatric symptoms less prevalent over time. But only specific domains, such as fatigue, negatively impacted quality of life.

"NMS are gaining increasing relevance in the management of PD and the use of dedicated questionnaires and scales may facilitate their clinical recognition and assessment," write Angelo Antonini (Istituti Clinici di Pefezionamento, Milan, Italy) and colleagues in the Journal of Neurology.

The team prospectively followed up 707 patients (62% males) from the PRIAMO (PaRkInson And non MOtor symptoms) cohort for 2 years. In a previous analysis, 98% of these patients reported at least one NMS, while the average number of NMS per patient was six.

The researchers assessed NMS using a semi-structured interview that explored symptoms assigned to 12 different domains (gastrointestinal, pain, urinary etc) each including up to 10 specific symptoms reported as ''present/absent'' in the month prior to the visit.

They found that individual NMS had variable evolution over the 2-year follow up. Sleep, gastrointestinal, attention/memory and skin disturbances (hyperhidrosis and seborrhea) became more prevalent over time, with incidences ranging from 1% for pain to 19% for skin symptoms.

By contrast, psychiatric, cardiovascular, apathy, and respiratory disorders became less prevalent, with remission rates ranging from 3% for apathy to 22% for cardiovascular problems.

The development of cardiovascular, apathy, urinary, psychiatric, and fatigue symptoms was associated with a significant diminishing in patients' quality of life.

During the observation period, 123 (17 %) patients worsened clinically while 584 remained stable. The total number of reported NMS increased over 24 months in patients with motor worsening, compared with stable patients.

Thirty-nine (3.4% of patients evaluable at baseline) patients died, with a mean age at death of 74 years. Patients who died were older, had significantly higher Hoehn and Yahr stage and motor score, and reported a greater number of NMS at baseline, compared with those who survived.

"The observation of a variable course as well as contribution to quality of life of different NMS domains may serve as basis for planning future studies targeting disturbances beyond motor features and possibly also for defining appropriate outcome measures in future neuroprotective trials," say Antonini et al.

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