Prevalence, Evolution of Non-Motor Symptoms in Parkinson’s Disease

by U.S. Medicine

November 9, 2017

CHICAGO—Parkinson’s disease (PD) can cause a wide range of motor and nonmotor symptoms (NMS).

In fact, many NMS, including hyposmia, rapid eye movement behavior disorder (RBD), depression, anxiety and constipation can occur in the earliest stages of the disease and might even precede the onset of motor disability.

Results of a study, Parkinson’s Progression Markers Initiative (PPMI), was published in the Journal of Neurology, Neurosurgery & Psychiatry seeking to determine the baseline prevalence and longitudinal evolution in NMS in a prospective cohort of patients with de novo PD compared with healthy controls (HC).

For the research, led by Northwestern University Feinberg School of Medicine researchers and including involvement from the Philadelphia VAMC, NMS were rated using the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part I score and other validated NMS scales at baseline and after two years. Biological variables included cerebrospinal fluid (CSF) markers and dopamine transporter imaging.

Overall, 423 PD patients and 196 controls were enrolled and followed for two years.

Results indicated that MDS-UPDRS Part I total mean (SD) scores increased from baseline 5.6 (4.1) to 7.7 (5.0) at Year Two in PD subjects vs. from 2.9 (3.0) to 3.2 (3.0) in HC, with a significant difference between the groups.

In the multivariate analysis, meanwhile, higher baseline NMS score was associated with female sex, higher baseline MDS-UPDRS Part II scores and more severe motor phenotype. Increase in NMS severity over time was associated with older age and lower CSF Aβ1–42 at baseline.

No association with the dose or class of dopaminergic therapy was detected.

“This study of NMS in early PD identified clinical and biological variables associated with both baseline burden and predictors of progression,” the study authors wrote. “The association of a greater longitudinal increase in NMS with lower baseline Aβ1–42 level is an important finding that will have to be replicated in other cohorts.”

  1. Simuni T, Caspell-Garcia C, Coffey CS, Weintraub D, et. al. Baseline prevalence and longitudinal evolution of non-motor symptoms in early Parkinson’s disease: the PPMI cohort. J Neurol Neurosurg Psychiatry. 2017 Oct 6. pii: jnnp-2017-316213. doi: 10.1136/jnnp-2017-316213. [Epub ahead of print] PubMed PMID: 28986467.

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