Prevalence of non motor features in a cohort of Parkinson's disease patients

Background

There is a lack of awareness among physicians of the considerable disability caused by non-motor symptoms (NMS) in PD. The aim of this work is to estimate the prevalence of NMS in a series of patients with Parkinson's disease (PD).

Materials and methods

We studied 112 patients with Parkinson's disease. Motor symptoms were scored on the Unified Parkinson's Disease Rating Scale (UPDRS) part III and the Hoehn and Yahr (HY) Scale. Other symptoms were quantified with the Non-Motor Symptom Questionnaire and Scale (NMSQuest and NMSS) as well as Minimental State Examination (MNSE).

Results

Analysis of the data from the NMSS showed that mood/cognition was the most commonly affected domain (prevalence rate = 87.5%), followed by sleep disturbance/fatigue second (78.6%). However, all other non-motor symptoms scored highly: gastrointestinal and urinary (76.8% for both), sexual dysfunction (73%), cardiovascular (70.5%) with significantly higher percentage in predominantly akinetic/rigid patients. Perceptual problems/hallucinations (9.9%) were infrequent in this population. Dementia was recorded in 22.3% of patients, most of them having a mild degree of dementia. UPDRS scores were correlated with total scores in both NMSQuest and NMSS.

Conclusions

Mood/cognition, sleep disorders, GIT, and sexual disorders were common non motor manifestations in this population of PD patients.     

The metric properties of a novel non-motor symptoms scale for Parkinson's disease: Results from an international pilot study.

Non-motor symptoms (NMS) in Parkinson's disease (PD) are common, significantly reduce quality of life and at present there is no validated clinical tool to assess the progress or potential response to treatment of NMS. A new 30-item scale for the assessment of NMS in PD (NMSS) was developed. NMSS contains nine dimensions: cardiovascular, sleep/fatigue, mood/cognition, perceptual problems, attention/memory, gastrointestinal, urinary, sexual function, and miscellany. The metric attributes of this instrument were analyzed. Data from 242 patients mean age 67.2 +/- 11 years, duration of disease 6.4 +/- 6 years, and 57.3% male across all stages of PD were collected from the centers in Europe, USA, and Japan. The mean NMSS score was 56.5 +/- 40.7, (range: 0-243) and only one declared no NMS. The scale provided 99.2% complete data for the analysis with the total score being free of floor and ceiling effect. Satisfactory scaling assumptions (multitrait scaling success rate >95% for all domains except miscellany) and internal consistency were reported for most of the domains (mean alpha, 0.61). Factor analysis supported the a prori nine domain structure (63% of the variance) while a small test-retest study showed satisfactory reproducibility (ICC > 0.80) for all domains except cardiovascular (ICC = 0.45). In terms of validity, the scale showed modest association with indicators of motor symptom severity and disease progression but a high correlation with other measures of NMS (NMSQuest) and health-related quality of life measure (PDQ-8) (both, rS = 0.70). In conclusion, NMSS can be used to assess the frequency and severity of NMS in PD patients across all stages in conjunction with the recently validated non-motor questionnaire.     

Prevalence of nonmotor symptoms in Parkinson's disease in an international setting; study using nonmotor symptoms questionnaire in 545 patients.

2006, there was, no single instrument (questionnaire or scale) for attempting a comprehensive assessment of the wide range of nonmotor symptoms (NMS) of Parkinson's disease (PD). The PD nonmotor group, a multidisciplinary group of experts including patient group representatives developed and validated the NMS screening questionnaire (NMSQuest) comprising 30 items. The NMSQuest is a self completed screening tool designed to draw attention to the presence of NMS. In this paper, we present the results gathered from 545 patients using the definitive version of the NMSQuest highlighting the prevalence of the wide range of NMS flagged in the NMSQuest from consecutive PD patients in an international setting.     

The nondeclaration of nonmotor symptoms of Parkinson's disease to health care professionals: An international study using the nonmotor symptoms questionnaire

The nonmotor symptoms (NMS) of Parkinson's disease (PD) are less well recognised and can be more troublesome to patients and carers than classical motor features. NMS are frequently missed during routine consultations and such under‐recognition may have implications on quality of care given that many NMS are treatable. To determine the proportion of patients not declaring NMS to healthcare professional (HCP) as assessed by self completion of the NMS questionnaire (NMSQuest), a validated, self‐completing questionnaire with 30 items. Multicentre international study. The data was collected from PD patients across all age groups and stages attending outpatient clinics in specialist and care of the elderly settings. 242 patients recruited and undeclared NMS ranged from 31.8% (diplopia) to 65.2% (delusions). The most frequently nondeclared symptoms were delusions, daytime sleepiness, intense and vivid dreams, and dizziness. In many, appropriate treatments for undeclared NMS were started only after these were recognised following completion of NMSQuest. NMS of PD are frequently undeclared at routine hospital consultation and may be related to the fact that patients often do not link these symptoms with PD or may be too embarrassed to discuss these. Use of NMSQuest allows patients to flag symptoms which may be otherwise undeclared and remain untreated when potential treatments exist. © 2010 Movement Disorder Society     

International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: the NMSQuest study.

Nonmotor symptoms (NMS) of Parkinson's disease (PD) are not well recognized in clinical practice, either in primary or in secondary care, and are frequently missed during routine consultations. There is no single instrument (questionnaire or scale) that enables a comprehensive assessment of the range of NMS in PD both for the identification of problems and for the measurement of outcome. Against this background, a multidisciplinary group of experts, including patient group representatives, has developed an NMS screening questionnaire comprising 30 items. This instrument does not provide an overall score of disability and is not a graded or rating instrument. Instead, it is a screening tool designed to draw attention to the presence of NMS and initiate further investigation. In this article, we present the results from an international pilot study assessing feasibility, validity, and acceptability of a nonmotor questionnaire (NMSQuest). Data from 123 PD patients and 96 controls were analyzed. NMS were highly significantly more prevalent in PD compared to controls (PD NMS, median = 9.0, mean = 9.5 vs. control NMS, median = 5.5, mean = 4.0; Mann-Whitney, Kruskal-Wallis, and t test, P < 0.0001), with PD patients reporting at least 10 different NMS on average per patient. In PD, NMS were highly significantly more prevalent across all disease stages and the number of symptoms correlated significantly with advancing disease and duration of disease. Furthermore, frequently, problems such as diplopia, dribbling, apathy, blues, taste and smell problems were never previously disclosed to the health professionals.     

Unexplained lower limb pain in Parkinson's disease: A phenotypic variant of “painful Parkinson's disease”

Unexplained pain is a key non-motor symptom (NMS) of Parkinson's disease (PD) that is prevalent throughout the condition and often unrecognized and under treated. We have identified a cluster of patients with unexplained refractory and intrusive lower limb pain.MethodsPatients with ‘unexplained’ pain were identified from a survey using a non-motor symptom questionnaire and scale (NMSQuest, NMSS). Patients reporting unexplained severe proximal lower limb pain were then assessed using a newly devised PD pain scale. Co-morbid conditions were excluded and all had lower spine imaging.ResultsFrom a cohort of 225 patients we have identified 22 with unexplained lower limb pain described as persistent leg pain ranging from unilateral to bilateral sometimes associated with whole body pain. None had significant spinal pathology or evidence of large fiber neuropathy. 14 were on regular analgesics with poor effect while 9 took morphine based remedies. Severe unremitting pain led to accidental overdose and death in one patient. All took a combination of levodopa and dopamine agonist treatment including 3 on intrajejunal levodopa infusion. All had high NMSQuest (mean = 17/30) and NMSS (mean = 95 (normal range 30–60)) scores.ConclusionsWe believe that unexplained lower limb pain is a specific non-motor phenotype in Parkinson's disease that is problematic and often undisclosed. This may be a variant of central pain and merits recognition.     

早期初诊帕金森病患者非运动症状的临床特征及影响因素分析

目的探讨早期帕金森病(PD)患者非运动症状(NMS)的临床特征及影响因素。方法收集门诊首次就诊且发病在1a内的早期PD患者105例和健康对照者100例,采用帕金森病非运动症状调查问卷(NMSQuest)进行NMS评估,结合临床特征等因素分析非运动症状发生的主要影响因素。结果 PD组NMS评分显著高于对照组(P0.05),发生率较高的症状依次为便秘(58例,55.2%)、记忆力下降(51例,48.6%)、情绪低落(43例,40.9%)。回归分析显示,H-Y分级、年龄及PD临床亚型是NMS评分的主要影响因素(P0.05),性别、文化程度、病程则与其无关。结论 NMS在早期PD患者中较常见且临床表现多样,需提高认识并及时干预。     

Is serum uric acid related to non-motor symptoms in de-novo Parkinson's disease patients?

BackgroundLow serum uric acid (UA) has been consistently shown to be associated with increased risk of Parkinson's disease (PD), and to predict faster motor and cognitive decline in established PD. The aim of the present study is to evaluate the relationship between serum UA and non-motor symptoms (NMS) in de novo PD.MethodsSerum UA was measured in consecutively recruited, early drug-naïve PD patients. Exclusion criteria were: treatment with UA modifying drugs; current smoking status; metabolic or cardiac morbidity. All patients completed the NMS Questionnaire (NMSQuest). The relationship between UA levels and NMSQuest domains was explored by logistic regression, subsequently adjusted for age, gender, disease duration (months since reported motor onset) UPDRS part III, H&Y scale, and MMSE. Regression analysis studied the overall relationship between UA levels and total NMS score, and was subsequently adjusted for age, gender, disease duration UPDRS part III, H&Y scale and MMSE.ResultsEighty PD patients were recruited. At logistic regression, higher UA levels were related to lower involvement of Attention/Memory (p = 0.004), Cardiovascular (0.009) and Sleep (p = 0.028) domains of NMSQuest. UA levels showed a significant negative correlation with total NMSQuest score at regression analysis (p = 0.001; Adjusted R-squared = 0.319).DiscussionThe present study investigated, for the first time, the relationship between NMSQuest and UA in de novo PD. Lower UA was related to higher NMSQuest total score and in particular to Attention/Memory, Cardiovascular and Sleep domains. Thus, UA seems to be a major candidate to be a valuable biomarker of such early features of PD as NMS.     

Executive dysfunction in non-demented Parkinson's disease patients with hallucinations

Objective –  We investigated executive function in Parkinson's disease (PD) patients, and focused on executive dysfunction in PD with hallucinations, but without dementia.
Methods –  PD patients were classified by cognitive or neuropsychotic status as PD group, PD with vivid dreaming group, PD with hallucinations group and Parkinson's disease dementia (PDD) group. Psychomotor speed tests, the Stroop test, a verbal fluency test and the Self-rating Depression Scale were performed.
Results –  The PDD group showed poorer scores in every test compared with the PD group. The PD with hallucinations group showed results similar to those of the PDD group, while the PD with vivid dreaming group was similar to the PD group.
Conclusions –  The study suggests that PD patients with hallucinations, not extensive enough to qualify as dementia, already have executive dysfunction similar to that seen in PDD patients. Executive dysfunction may be an important substrate for hallucinations even when dementia is not yet apparent.     

帕金森病非运动症状及其治疗的流行病学调查

目的 调查帕金森病(Parkinson’s Disease, PD)非运动症状(Non-motor symptom, NMS)的发生率、严重程度、持续时间、治疗情况及其对生活质量的影响。方法 2014年1月～2016年4月对139例PD患者和87例健康成人(对照组)运用非运动症状评分(Non-Motor Symptoms Scale,NMSS)调查NMS,运用帕金森病生活质量问卷39项(39-item Parkinson’s Disease Questionnaire,PDQ-39)评估生活质量,运用Hoehn& Yahr(H-Y)分级评定PD患者运动症状的严重程度,并记录研究对象的一般情况和治疗情况,分析PD患者生活质量的影响因素。结果 98.6%的PD患者存在NMS,平均NMSS总分[(61.46±41.92),(0～208)]。在PD患者中发生率超过50%的NMS依次如下:夜尿、便秘、不宁腿、性欲下降、性功能障碍、失眠、乏力; 平均NMSS≥3分的NMS依次如下:便秘、性欲下降、性功能障碍、乏力、失眠、不宁腿、尿频、夜尿; 平均持续时间≥2年的NMS依次如下:便秘、性欲改变、夜尿、勃起障碍、快速动眼睡眠行为异常(REM Sleep Behavior Disorder Questionnaire,RBD)、嗅觉障碍。PD患者中通便药、安眠药、抗抑郁药和排尿困难药的使用率分别为47.8%(43/90)、19.7%(13/66)、2.7%(2/74)、2.6%(2/76)。PD患者中通便药使用率显著多于正常人群(P<0.0001),2组安眠药使用率比较无明显差异(P=0.736),对照组无人使用改善情绪和排尿困难的药物。多重线性回归分析发现,调查时年龄、H-Y分级和NMS总分是PD患者日常生活质量的预测因素。结论 NMS几乎见于每例PD患者,自主神经功能紊乱、嗅觉障碍和RBD等NMS可用于辅助PD早期诊断,NMS降低PD患者的生活质量,需要加强对NMS的关注。     

Intrajejunal levodopa infusion in Parkinson's disease: A pilot multicenter study of effects on nonmotor symptoms and quality of life

Switching from oral medications to continuous infusion of levodopa/carbidopa gel reduces motor complications in advanced Parkinson's disease (PD), but effects on nonmotor symptoms (NMSs) are unknown. In this prospective open‐label observational study, we report the effects of intrajejunal levodopa/carbidopa gel infusion on NMS in PD based on standard assessments utilizing the nonmotor symptoms scale (NMSS) along with the unified Parkinson's disease rating scale (UPDRS 3 motor and 4 complications) and quality of life (QoL) using the Parkinson's disease questionnaire (PDQ‐8). Twenty‐two advanced PD patients (mean age 58.6 years, duration of disease 15.3 years) were followed for 6 months. A statistically significant beneficial effect was shown in six of the nine domains of the NMSS: cardiovascular, sleep/fatigue, attention/memory, gastrointestinal, urinary, and miscellaneous (including pain and dribbling) and for the total score of this scale (NMSST) paralleling improvement of motor symptoms (UPDRS 3 motor and 4 complications in “best on” state) and dyskinesias/motor fluctuations. In addition, significant improvements were found using the Parkinson's disease sleep scale (PDSS) and the PDQ‐8 (QoL). The improvement in PDQ‐8 scores correlated highly significantly with the changes in NMSST, whereas a moderately strong correlation was observed with UPDRS changes. This is the first demonstration that a levodopa‐based continuous dopaminergic stimulation is beneficial for NMS and health‐related quality of life in PD in addition to the reduction of motor fluctuations and dyskinesias. © 2009 Movement Disorder Society     

Validation of the Italian version of the Non Motor Symptoms Scale for Parkinson's disease

ObjectiveTo validate the adapted Italian version of the Non-Motor Symptoms Scale (NMSS), a tool to assess non-motor symptoms (NMS) in Parkinson's disease (PD).MethodsA cross cultural adaptation of the NMSS into Italian and a psychometric analysis of the translated version of the NMSS was carried out in patients with PD from two university centres–affiliated hospitals. The quality of data and the acceptability, reliability and construct validity of NMSS were analyzed. The following standard scales were also applied: Hoehn and Yahr staging, Unified Parkinson's Disease Rating Scale (UPDRS) part III, Montreal Cognitive Assessment, Beck Depression Inventory, Neuropsychiatric Inventory, Epworth Sleepiness Scale, Autonomic Scale for Outcomes in Parkinson's disease-Motor, Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part I and Modified Cumulative Illness Rating Scale (CIRS). Levodopa equivalent daily dose (LEDD) was calculated.ResultsSeventy-one patients with PD were assessed (mean age years 69.8 ± 9.6 SD; 31% women; mean length of disease 6.3 ± 4.6 years; H&Y median: 2). Mean NMSS was 39.76 (SD 31.9; skewness 0.95). The total score of NMSS was free of floor or ceiling effects and showed a satisfactory reliability (Cronbach's alpha coefficient on total score was 0.72 [range for domains: 0.64–0.73], SEM value was 3.88 [½ SD = 31.90]). Significant positive correlations were found among total NMSS and other NMS standard tests, but no significant correlation appeared with UPDRS part III, CIRS and LEDD.ConclusionsThe Italian NMSS is a comprehensive and helpful measure for NMS in native Italian patients with PD.     

Evaluation of an Arabic version of the non-motor symptoms scale in Parkinson’s disease

Non-motor symptoms (NMS) of Parkinson Disease (PD) are common and can cause severe disability. They are often under-recognized and remain untreated. Tools to evaluate these symptoms in Arabic-speaking patients are still lacking. The objective of this study was to evaluate an Arabic version of the non-motor symptoms scale (NMSS) of PD as an instrument for measuring NMS in Arabic-speaking patients. Sixty-two PD patients clustered around Hoehn & Yahr Stages 2–3 were evaluated by the Arabic version of NMSS. They also underwent a battery of standard psychometric assessment measures that included the scales for outcomes of Parkinson’s disease-autonomic (SCOPA-AUT), the Pittsburgh sleep quality index (PSQI), the Beck depression inventory, the geriatric depression scale (GDS), the mini-mental state examination (MMSE), the visual analogical scale for pain(VAS) and the neuro-psychiatric inventory (NPI). The metric properties of the NMSS were studied as well as its correlation with other standard tests evaluating NMS. The mean NMSS score was 82 ± 56 (skewness 0.88). There were highly significant correlations between the NMSS and the SCOPA-AUT as well as the NMSS and PSQI scores. Significant positive correlations between NMSS and GDS, BECK and VAS were also observed. The sleep/fatigue domain significantly correlated with the PSQI, the cardiovascular/urinary/sexual function/gastrointestinal domains significantly correlated with the SCOPA-AUT, the mood/cognition domain significantly correlated with the GDS and BECK findings. The mean Cronbach’s alpha coefficient was 0.87, showing a satisfactory internal consistency. The Arabic version of NMSS can be considered a comprehensive and reliable measure for non-motor symptoms in Arabic-speaking PD patients.     

Validation of the sleep related items of the Non-motor Symptoms Questionnaire for Parkinson's disease (NMSQuest)

BackgroundThe Non-motor Symptoms Questionnaire (NMSQuest) is a recently developed questionnaire for the evaluation of non-motor symptoms in Parkinson's disease (PD) patients, which includes sleep disorders evaluation. The clinical validity of the questionnaire has not been explored.ObjectiveTo assess the performance of the sleep/fatigue domain of the NMSQuest against other sleep measures.MethodsSeventy PD patients were instructed to wear an actigraph and to fill in a sleep log over seven consecutive days in addition to the Parkinson's Disease Sleep Scale (PDSS) and the NMSQuest.ResultsPD patients who reported daytime sleepiness on NMSQuest obtained a significantly worse score on the PDSS sleepiness domain than PD patients who did not (12.0 ± 4.7 vs. 14.7 ± 3.4, p < 0.009). Patients reporting difficulty getting to sleep or staying asleep at night, showed lower scores on PDSS sleep quality domain than those without difficulties (15.8 ± 5.4 vs. 22.3 ± 4.6, p < 0.001). The presence of vivid dreams, acting out dreams and restlessness on NMSQuest correlated with PDSS and sleep log scores. Increased nocturnal activity was noted in subjects reporting acting out dreams. Furthermore, the number of positive answers to the sleep-fatigue questions of the NMSQuest correlated significantly with PDSS total score, sleep log total score and nocturnal activity measured by actigraphy.ConclusionNMSQuest sleep-fatigue domain identified appropriately sleep disturbances indicating its usefulness as a screening tool for sleep disorders in PD patients.     

Gender and onset age-related features of non-motor symptoms of patients with Parkinson's disease – A study from Southwest China

BackgroundNon-motor symptom (NMS) differences between male Parkinson's disease (PD) and female PD, and between early-onset PD (EOPD) and late-onset PD (LOPD) in Chinese populations remain largely unknown.MethodsA total of 522 PD patients from Southwest China were included. Patients were assessed using the Non-Motor Symptom Scale (NMSS) and Unified PD Rating Scale (UPDRS).ResultsMore NMS and significantly higher NMSS score were found in LOPD patients than in EOPD patients (9.3 ± 5.9 vs. 7.7 ± 5.6, P = 0.005; 37.4 ± 32.2 vs. 30.5 ± 28.9, P = 0.018), while no such differences were found between male and female patients. The NMS of gastrointestinal and urinary domains were more common in LOPD patients than in EOPD patients, whereas sexual dysfunction was more common in EOPD than in LOPD. The sleep/fatigue domain, the mood/apathy domain and “pain” symptoms were more prevalent and severe in female patients than in male patients while urinary symptoms were more common and severe in male patients. Significant positive correlations were observed between disease duration, Hoehn & Yahr stage, UPDRS Ⅲ, and NMSS score in the total sample, subgroups of both male and female patients as well as both EOPD and LOPD patients.ConclusionsNMS are common in the Chinese PD population. LOPD patients are likely to present with more and severe NMS than EOPD patients. Males are subjected to urinary symptoms and females are subjected to mood/apathy, sleep and pain symptoms.     

Nonmotor symptoms more closely related to Parkinson's disease: Comparison with normal elderly

Nonmotor symptoms (NMSs) commonly occur in Parkinson's disease (PD). This study sought to explore the domains of NMSs that are more closely related to PD using nonmotor symptoms scale (NMSS), through a quantitative comparison of NMSs' prevalence and NMSS scores of PD patients with normal controls, and clinical implications. We performed a prospective case–control study on PD patients (n = 131) and age- and gender-matched normal controls (n = 129). We compared NMSs' prevalence and NMSS scores of the PD patients with those of normal controls, and obtained the ratio to identify the domains that were more closely related to PD than normal aging using the NMSS. NMSs are very common among normal elderly as well as PD patients. The domains with the highest ratio of NMSs' prevalence and NMSS scores between the patient and control groups were the miscellaneous, perceptual problems/hallucinations, and sexual function. These three domains were found to be most closely related to PD. NMSs with higher prevalence in PD patients do not always relate more to PD. As NMSs in PD can also commonly occur among the normal elderly, the NMS prevalence should be interpreted with extreme caution. To properly manage the NMSs in PD, it should be kept in mind that avoiding the overestimation of NMSs as part of PD is as important as their early recognition in PD.     

Validation of the Chinese Non-Motor Symptoms Scale for Parkinson's disease: Results from a Chinese pilot study

Objectives

To evaluate a Chinese version of the Non-Motor Symptoms Scale (NMSS) in Parkinson's disease (PD) as an instrument for measuring non-motor symptoms (NMSs) in Chinese patients with Parkinson's disease.

Methods

We conducted a psychometric analysis of the Chinese version of NMSS using a cross-sectional study of 126 patients with PD. The battery also included the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Hamilton Anxiety Scale (HAMA), and was conducted by neurologists.

Results

There were significant correlations between the NMSS and PSQI scores (rS = 0.63, P < 0.001), as well as the NMSS and ESS scores (rS = 0.38, P < 0.001). Furthermore, significant positive correlations between NMSS and GDS, NMSS and HAMA, and NMSS and disease duration were also observed. Importantly, the sleep/fatigue index of the NMSS significantly correlated with the PSQI and ESS findings, the mood/cognition index of the NMSS significantly correlated with the GDS and HAMA findings, and the attention/memory index of the NMSS significantly correlated with the MMSE findings.

Conclusion

The Chinese version of the NMSS can be considered a comprehensive, useful measure for NMS evaluation in Chinese PD patients.     

Relationships between disability, quality of life and prevalence of nonmotor symptoms in Parkinson's disease

Patients with Parkinson's disease suffer from a variety of motor and nonmotor symptoms (NMS), report reduced quality of life and increased disability. Aims of this study are to assess the impact of Parkinson's disease on disability and quality of life, to evaluate the relationships between them and NMS prevalence. In this cross-sectional study, adult patients were consecutively enrolled and administered the World Health Organization Disability Assessment Schedule (WHO-DAS II), the 36-Item Short-Form Health Survey (SF-36) and the Non Motor Symptoms Questionnaire (NMSQuest). One-sample t-test was used to compare WHO-DAS II and SF-36 scores with normative value. Pearson's correlation was performed between NMSQuest, WHO-DAS II and SF-36 summary scales. Independent-sample t-test was used to compare NMSQuest, WHO-DAS II and SF-36 scores in patients with Hoehn & Yahr stage <3 and ≥ 3. In total, 96 patients were enrolled. SF-36 and WHO-DAS II scores were significantly worse than the normative values. Correlation coefficients between NMSQuest, WHO-DAS II and SF-36's mental score were moderate, and were high between WHO-DAS II and and SF-36's physical score. Patients with Hoehn & Yahr stage ≥ 3 reported reduced quality of life, higher disability and more NMS. Parkinson's disease severity is strongly associated with reduced quality of life, increased disability and NMS prevalence. Disability and quality of life assessment tools measure psychosocial facets that are similar specifically with regard to physical health component of health-related quality of life, are sensitive enough to capture differences related to disease's progression and increased prevalence of NMS.     

Non-motor symptoms in Chinese Parkinson’s disease patients

This study was designed to survey the prevalence and distribution of non-motor symptoms (NMS) in Parkinson’s disease (PD) patients in Shanghai, China, and to investigate the association between NMS and health-related quality of life (HRQoL). One hundred fifty-five PD patients were evaluated using the NMS Questionnaire 30 (NMSQuest), Unified Parkinson’s Disease Rating Scale (UPDRS) and Parkinson’s Disease Questionnaire-39 (PDQ-39). These data were compared with an international cross-sectional study, and the associations of motor and non-motor measures with HRQoL were estimated. Predictors of HRQoL were sought through multiple linear regression analyses. Each PD patient had eight different individual NMS on average. The problems of memory (65.82%), constipation (64.56%) and nocturia (61.39%) were the most frequent complaints. NMS prevalence in PD patients in Shanghai was consistent with that in the international study, although the composition proportions were different. There was a significant association of PDQ-39 score with NMSQuest score (rs = 0.433, p = 0.000), UPDRS III score (rs = 0.473, p = 0.000), Hoehn and Yahr (H-Y) stage (rs = 0.567, p = 0.000), disease duration (rs = 0.220, p = 0.005), and levodopa equivalent dosage (rs = 0.263, p = 0.001). H-Y stage (disease severity) and NMS score were the strongest predictors for PDQ-39 score. This study confirmed that NMS are common in PD, occurring across all disease stages and have a great impact on quality of life. NMS progression contributes significantly to HRQoL decline, and should be well recognized and treated.     

Assessment of hallucinations in Parkinson's disease using a novel scale

Objective –  To assess hallucinations in Parkinson's disease (PD), we developed a novel practical rating scale that evaluates five items including variety, frequency, and severity of hallucinations, caregiver burden levels, and psychiatric status at nighttime.
Methods –  Forty-one PD patients and their caregivers were examined regarding the status of the hallucinations associated with PD.
Results –  As a measure of internal consistency, the Tottori University Hallucination Rating Scale (TUHARS) has a Cronbach's α of 0.88. Mini-Mental State Examination (MMSE) and Hoehn–Yahr stage were associated with the TUHARS scores in a multivariate regression analysis. Visual hallucinations are the most common. However, half of the patients who reported visual hallucinations also had other hallucinations. The scale scores in the PD patients with dementia (PDD) group were significantly greater than in the PD patients without dementia (PDnD) group.
Conclusions –  TUHARS appears to be a suitable and easily administered instrument for assessment of hallucinations in PD. PD patients experienced various kinds of hallucinations. Hallucinations may have a close relationship with cognitive decline in PD patients.