Severe nonmotor symptom burden common in early Parkinson’s

By Eleanor McDermid, Senior medwireNews Reporter

Almost all patients with early Parkinson’s disease (PD) have nonmotor symptoms (NMSs), with more than a third having a severe burden of symptoms, a study shows.

“This observation is clinically relevant as a common perception is that whilst NMSs may be common in early PD patients, treated or [drug naïve], the symptoms may not be severe”, say researcher Kallol Ray Chaudhuri (King's College Hospital NHS Foundation Trust, London, UK) and team.

Among the 170 patients with treated early PD (≤5 years from diagnosis), the burden of NMSs was mild in 29.4%, moderate in 34.1%, severe in 21.2% and very severe in 15.3%. The corresponding rates among 64 drug-naïve patients were 28.1%, 29.7%, 21.9% and 18.8%, while 1.6% had no NMSs.

As reported in the European Journal of Neurology, the team rated the patients’ NMSs on the Non-Motor Symptoms Scale (NMSS), producing a combined score of severity and frequency to reflect symptom burden. Patients, whether treated or drug naïve, tended to report the same NMSs, with scores being similar for all nine domains of the NMSS.

Some of the most common NMSs were fatigue, reported by 57.6% and 57.8% of each group, respectively, while memory difficulties were reported by 51.2% and 48.4%, and urinary urgency by 57.1% and 46.9%.

The similarities between the two groups causes the researchers to conclude that “[t]he NMSs in these cases are very likely to be disease process related rather than related to dopaminergic drug intake.”

In addition, 57.8% of the drug-naïve group reported sadness and had poor mood/apathy, yet self-reported anxiety/depression was worse in treated patients. The researchers suggest this could be due to differences between self and clinician rating, but could also be because treated patients have a more negative perception of their condition, whereas untreated patients “still have the hope of a ‘benign’ disease”.

The team concludes: “The NMS burden appears considerable compared to the motor burden at this stage suggesting that these observations have clinical implications and should pave the way to studies for non-motor subtyping within PD.”

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