To determine the impact of nonmotor symptoms (NMS) on health-related quality of life (HRQoL) we examined 100 Parkinson’s disease (PD) patients on dopaminergic medications. An “early-stage” (ES) and an “advanced-stage” (AS) groups were formed. HRQoL was established by the questionnaire PDQ-8, number of NMS by NMSQuest, and severity and frequency of NMS by the assessment scale NMSS. The total NMS averaged 11.3 , . The NMSS domain correlation profiles for ES and AS did not fundamentally differ; however, the domains attention/memory and mood/apathy correlated moderately to strongly with HRQoL in ES, while the sleep/fatigue domain correlated moderately with HRQoL in AS. Weakly correlating domains were sleep/fatigue in ES and cardiovascular, attention/memory, and mood/apathy domains in AS. In view of these findings we strongly recommend systematic, active screening and therapy for neuropsychiatric disorders (mood, cognitive and sleep disorders, and fatigue) at the initial diagnosis and throughout the entire course of PD. 1. Introduction Parkinson’s disease (PD) is a progressive, complex disorder characterized by motor symptoms (bradykinesia, rigidity, resting tremor, and postural instability) as well as a wide range of nonmotor symptoms (NMS) that contribute to significant morbidity and disability [1, 2]. It is important to identify those NMS that most influence the patient’s life, since they may not be evident during the clinical examination [3]. NMS like depression, anxiety, cognitive decline, pain, fatigue, insomnia, and autonomic dysfunction (constipation, urinary symptoms) are significant factors that diminish health-related quality of life (HRQoL) of individuals with PD [4–6]. While common, they are still often underrecognized in clinical practice because patients fail to spontaneously mention them, and healthcare professionals also fail to systematically ask about them [5, 7]. Nonmotor symptoms occur not only in advanced but also in early stages of PD. Some symptoms, for example, olfactory deficit, constipation, rapid-eye movement sleep behavior disorder, and depression, can even precede the appearance of motor symptoms by many years [8]. Most of the PD-associated NMS are believed to be caused by the nondopaminergic systems, in accordance with the hypothesis that other neurotransmitters including serotoninergic, noradrenergic, and cholinergic transmission are involved [9]. However, in a recent study on advanced PD subjects, Storch and coworkers [10] showed that seven out of ten selected NMS (with the exception of dysphagia, excessive sweating, and
References
[1]
M. Drobny and E. Kur？a, “Possible extrapyramidal system degradation in Parkinson’s disease,” Brain Research Bulletin, vol. 53, no. 4, pp. 425–430, 2000.
[2]
K. R. Chaudhuri, J. M. Rojo, A. H. Schapira et al., “A proposal for a comprehensive grading of Parkinson's disease severity combining motor and non-motor assessments: meeting an unmet need,” PLoS ONE, vol. 8, Article ID e57221, 2013.
[3]
P. Martinez-Martin, C. Rodriguez-Blazquez, M. M. Kurtis, and K. R. Chaudhuri, “The impact of non-motor symptoms on health-related quality of life of patients with Parkinson's disease,” Movement Disorders, vol. 26, no. 3, pp. 399–406, 2011.
[4]
S.-E. Soh, M. E. Morris, and J. L. McGinley, “Determinants of health-related quality of life in Parkinson's disease: a systematic review,” Parkinsonism & Related Disorders, vol. 17, no. 1, pp. 1–9, 2011.
[5]
D. A. Gallagher, A. J. Lees, and A. Schrag, “What are the most important nonmotor symptoms in patients with Parkinson's disease and are we missing them?” Movement Disorders, vol. 25, no. 15, pp. 2493–2500, 2010.
[6]
J. Shearer, C. Green, C. E. Counsell, and J. P. Zajicek, “The impact of motor and non motor symptoms on health state values in newly diagnosed idiopathic Parkinson's disease,” Journal of Neurology, vol. 259, no. 3, pp. 462–468, 2012.
[7]
A. M. Bonnet, M. F. Jutras, V. Czernecki, J. C. Corvol, and M. Vidailhet, “Nonmotor symptoms in Parkinson's disease in 2012: relevant clinical aspects,” Parkinson's Disease, vol. 2012, Article ID 198316, 15 pages, 2012.
[8]
K. R. Chaudhuri and A. H. Schapira, “Non-motor symptoms of Parkinson's disease: dopaminergic pathophysiology and treatment,” The Lancet Neurology, vol. 8, no. 5, pp. 464–474, 2009.
[9]
J. E. Ahlskog, “Beating a dead horse: dopamine and Parkinson disease,” Neurology, vol. 69, no. 17, pp. 1701–1711, 2007.
[10]
A. Storch, C. B. Schneider, M. Wolz et al., “Nonmotor fluctuations in Parkinson disease: severity and correlation with motor complications,” Neurology, vol. 80, no. 9, pp. 800–809, 2013.
[11]
A. J. Hughes, S. E. Daniel, S. Blankson, and A. J. Lees, “A clinicopathologic study of 100 cases of Parkinson's disease,” Archives of Neurology, vol. 50, no. 2, pp. 140–148, 1993.
[12]
J. Jankovic, M. McDermott, J. Carter et al., “Variable expression of Parkinson's disease: a base-line analysis of the DATATOP cohort,” Neurology, vol. 40, no. 10, pp. 1529–1534, 1990.
[13]
C. L. Tomlinson, R. Stowe, S. Patel, C. Rick, R. Gray, and C. E. Clarke, “Systematic review of levodopa dose equivalency reporting in Parkinson's disease,” Movement Disorders, vol. 25, no. 15, pp. 2649–2653, 2010.
[14]
C. Jenkinson, R. Fitzpatrick, V. Peto, R. Greenhall, and N. Hyman, “The PDQ-8: development and validation of a short-form Parkinson's disease questionnaire,” Psychology & Health, vol. 12, no. 6, pp. 805–814, 1997.
[15]
K. R. Chaudhuri, P. Martinez-Martin, A. H. Schapira et al., “International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: the NMSQuest study,” Movement Disorders, vol. 21, no. 7, pp. 916–923, 2006.
[16]
K. R. Chaudhuri, P. Martinez-Martin, R. G. Brown et al., “The metric properties of a novel non-motor symptoms scale for Parkinson's disease: results from an international pilot study,” Movement Disorders, vol. 22, no. 13, pp. 1901–1911, 2007.
[17]
T. D. V. Swinscow and M. J. Campbell, Statistics at Square One, BMJ, London, UK, 9th edition, 1997.
[18]
D. Crosiers, B. Pickut, J. Theuns et al., “Non-motor symptoms in a Flanders-Belgian population of 215 Parkinson's disease patients as assessed by the Non-Motor Symptoms Questionnaire,” American Journal of Neurodegenerative Disease, vol. 1, no. 2, pp. 160–167, 2012.
[19]
P. Barone, A. Antonini, C. Colosimo et al., “The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease,” Movement Disorders, vol. 24, no. 11, pp. 1641–1649, 2009.
[20]
M. Skorvanek, J. Rosenberger, Z. Gdovinova et al., “Apathy in elderly nondemented patients with Parkinson's disease: clinical determinants and relationship to quality of life,” Journal of Geriatric Psychiatry and Neurology, vol. 26, no. 4, pp. 237–243, 2013.
[21]
C. Hinnell, C. S. Hurt, S. Landau et al., “Nonmotor versus motor symptoms: how much do they matter to health status in Parkinson's disease?” Movement Disorders, vol. 27, no. 2, pp. 236–241, 2012.
[22]
E. Havlikova, J. P. van Dijk, I. Nagyova et al., “The impact of sleep and mood disorders on quality of life in Parkinson's disease patients,” Journal of Neurology, vol. 258, no. 12, pp. 2222–2229, 2011.
