TY - JOUR
T1 - The progression of non-motor symptoms in Parkinson's disease and their contribution to motor disability and quality of life
AU - Antonini, Angelo
AU - Barone, Paolo
AU - Marconi, Roberto
AU - Morgante, Letterio
AU - Zappulla, Salvatore
AU - Pontieri, Francesco Ernesto
AU - Ramat, Silvia
AU - Ceravolo, Maria Gabriella
AU - Meco, Giuseppe
AU - Cicarelli, Giulio
AU - Pederzoli, Massimo
AU - Manfredi, Michela
AU - Ceravolo, Roberto
AU - Mucchiut, Marco
AU - Volpe, Giampiero
AU - Abbruzzese, Giovanni
AU - Bottacchi, Edo
AU - Bartolomei, Luigi
AU - Ciacci, Giuseppe
AU - Cannas, Antonino
AU - Randisi, Maria Giovanna
AU - Petrone, Alfredo
AU - Baratti, Mario
AU - Toni, Vincenzo
AU - Cossu, Giovanni
AU - Del Dotto, Paolo
AU - Bentivoglio, Anna Rita
AU - Abrignani, Michele
AU - Scala, Rossana
AU - Pennisi, Franco
AU - Quatrale, Rocco
AU - Gaglio, Rosa Maria
AU - Nicoletti, Alessandra
AU - Perini, Michele
AU - Avarello, Tania
AU - Pisani, Antonio
AU - Scaglioni, Augusto
AU - Martinelli, Paolo Emilio
AU - Iemolo, Francesco
AU - Ferigo, Laura
AU - Simone, Pasqualino
AU - Soliveri, Paola
AU - Troianiello, Biagio
AU - Consoli, Domenico
AU - Mauro, Alessandro
AU - Lopiano, Leonardo
AU - Nastasi, Giuseppe
AU - Colosimo, Carlo
PY - 2012
Y1 - 2012
N2 - Non-motor symptoms are gaining relevance in Parkinson's disease (PD) management but little is known about their progression and contribution to deterioration of quality of life. We followed prospectively 707 PD patients (62 % males) for 2 years. We assessed non-motor symptoms referred to 12 different domains, each including 1-10 specific symptoms, as well as motor state (UPDRS), general cognition, and life quality. Hoehn & Yahr (H&Y) stage was used to categorize patient status (I-II mild; III moderate; IV-V severe). We found that individual non-motor symptoms had variable evolution over the 2-year follow-up with sleep, gastrointestinal, attention/memory and skin disturbances (hyperhidrosis and seborrhea) becoming more prevalent and psychiatric, cardiovascular, and respiratory disorders becoming less prevalent. Development of symptoms in the cardiovascular, apathy, urinary, psychiatric, and fatigue domains was associated with significant life-quality worsening (p < 0.0045, alpha with Bonferroni correction). During the observation period, 123 patients (17 %) worsened clinically while 584 were rated as stable. There was a fivefold greater increase in UPDRS motor score in worse compared with stable patients over 24 months (p < 0.0001 vs. baseline both in stable and worse group). The total number of reported non-motor symptoms increased over 24 months in patients with motor worsening compared to stable ones (p < 0.001). Thirty-nine patients died (3.4 % of patients evaluable at baseline) with mean age at death of 74 years. Deceased patients were older, had significantly higher H&Y stage and motor score, and reported a greater number of non-motor symptoms at baseline. In conclusion, overall non-motor symptom progression does not follow motor deterioration, is symptom-specific, and only development of specific domains negatively impacts quality of life. These results have consequences for drug studies targeting non-motor features.
AB - Non-motor symptoms are gaining relevance in Parkinson's disease (PD) management but little is known about their progression and contribution to deterioration of quality of life. We followed prospectively 707 PD patients (62 % males) for 2 years. We assessed non-motor symptoms referred to 12 different domains, each including 1-10 specific symptoms, as well as motor state (UPDRS), general cognition, and life quality. Hoehn & Yahr (H&Y) stage was used to categorize patient status (I-II mild; III moderate; IV-V severe). We found that individual non-motor symptoms had variable evolution over the 2-year follow-up with sleep, gastrointestinal, attention/memory and skin disturbances (hyperhidrosis and seborrhea) becoming more prevalent and psychiatric, cardiovascular, and respiratory disorders becoming less prevalent. Development of symptoms in the cardiovascular, apathy, urinary, psychiatric, and fatigue domains was associated with significant life-quality worsening (p < 0.0045, alpha with Bonferroni correction). During the observation period, 123 patients (17 %) worsened clinically while 584 were rated as stable. There was a fivefold greater increase in UPDRS motor score in worse compared with stable patients over 24 months (p < 0.0001 vs. baseline both in stable and worse group). The total number of reported non-motor symptoms increased over 24 months in patients with motor worsening compared to stable ones (p < 0.001). Thirty-nine patients died (3.4 % of patients evaluable at baseline) with mean age at death of 74 years. Deceased patients were older, had significantly higher H&Y stage and motor score, and reported a greater number of non-motor symptoms at baseline. In conclusion, overall non-motor symptom progression does not follow motor deterioration, is symptom-specific, and only development of specific domains negatively impacts quality of life. These results have consequences for drug studies targeting non-motor features.
KW - Cognition
KW - Mortality
KW - Non-motor symptoms
KW - Parkinson’s disease
KW - Cognition
KW - Mortality
KW - Non-motor symptoms
KW - Parkinson’s disease
UR - http://hdl.handle.net/10807/27961
U2 - 10.1007/s00415-012-6557-8
DO - 10.1007/s00415-012-6557-8
M3 - Article
SN - 0340-5354
SP - N/A-N/A
JO - Journal of Neurology
JF - Journal of Neurology
ER -