Screening for nonmotor symptoms in early Parkinson’s urged

Nov 14 2013

By Eleanor McDermid, Senior medwireNews Reporter

Nonmotor symptoms (NMS) have a substantial impact on the health-related quality of life (HRQoL) of patients with early Parkinson’s disease (PD), research shows.

“Our results emphasize the importance of screening for NMS not only in the more advanced stages of PD, but at time of diagnosis,” write lead study author Gordon Duncan (Newcastle University, UK) and team in Movement Disorders.

There are proposals for a PD grading scheme that combines motor symptoms and NMS, they observe. “Such an approach could enhance the clinician’s ability to address the features of PD more holistically, which impact upon quality of life and disability.”

NMS were common among the 158 PD patients in the study. All were newly diagnosed, so 80% had a Hoehn and Yahr stage of 1 or 2, but they had an average of 8.3 symptoms on the Non-Motor Symptoms Questionnaire, compared with 2.8 in 99 controls of similar age and gender.

NMS were most common in patients with the postural instability with gait difficulty PD subtype, at an average of 9.3 symptoms per patient, compared with 7.5 and 6.3 in patients with the intermediate and tremor-dominant subtypes, respectively.

The most frequent symptoms included hypersalivation and dribbling (in 55.1% of patients), urinary urgency (45.6%), hyposmia (44.3%), anxiety (42.4%), and constipation (42.4%). All these were significantly more common than in controls, but, of these, only anxiety significantly contributed to poorer HRQoL on the Parkinson’s Disease Quality of Life Questionnaire (PDQ-39).

Memory complaints significantly affected HRQoL, and were very frequent in the patients, at 53.8%, but were also commonly reported by the controls, at 40.8%.

Other NMS that were significantly associated with worse HRQoL were sleep disturbance, which occurred in 46.8% of patients, and depression and impaired concentration, which were less common, reported by 14.6% and 29.1%, respectively.

Linear regression analysis also identified memory problems, depression, impaired concentration, and anxiety as predictors of poor HRQoL, along with REM sleep behavior disorder, the feeling of incomplete bowel emptying, hyperhydrosis, leg swelling, and diplopia. These factors collectively accounted for almost half of the variation in HRQoL.

“Improved awareness and understanding of the relationship between NMS, disability, and HRQoL will encourage a multidisciplinary approach to patient care and facilitate the provision of more comprehensive education for patients and caregivers,” concludes the team.

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