title: Clinical features and varieties of non-motor fluctuations in Parkinson's disease: a Japanese multicenter study.
abstract: OBJECTIVE
  This multicenter cross-sectional study aimed to investigate the clinical features and varieties of non-motor fluctuation in Parkinson's disease (PD).
  
  
  METHODS
  To identify motor and non-motor fluctuation, we employed the wearing-off questionnaire of 19 symptoms (WOQ-19) in 464 PD patients. We compared the frequency of levodopa-related fluctuation as identified by the WOQ-19 with recognition by neurologists. We compared patients with both motor and non-motor fluctuations with those who only had motor fluctuations. Non-motor fluctuations were separated into psychiatric, autonomic, and sensory categories for further analysis.
  
  
  RESULTS
  The patients' average age was 70.8 ± 8.4 years (mean ± SD) and disease duration was 6.6 ± 5.0 years. The frequency of motor fluctuations was 69% and for non-motor fluctuation 40%. Fifty-three percent of patients with motor fluctuations also had non-motor fluctuations, whereas 93% of patients with non-motor fluctuations also had motor fluctuations. The WOQ-19 showed a sensitivity of 82% but a specificity of only 40%. The patients with both non-motor and motor fluctuations exhibited more severe motor symptoms, more non-motor symptoms and higher levodopa daily doses (p < 0.05). Patients had significantly higher fluctuation rates if they had psychiatric (49%) and sensory (45%) symptoms than patients with autonomic symptoms (32%, p < 0.01). Forty-eight percent of patients with non-motor fluctuations exhibited more than one type of non-motor fluctuation.
  
  
  CONCLUSIONS
  Forty percent of PD patients presented with non-motor fluctuations, and almost half of these exhibited more than one type. Appropriate recognition of levodopa-related fluctuations, both motor and non-motor, can lead to treatment modifications in PD patients.
authors.affiliation: Department of Neurology, Keio University School of Medicine, 35-Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
authors.forename: Morinobu
authors.initials: M
authors.lastname: Seki
authors.forename: Kazushi
authors.initials: K
authors.lastname: Takahashi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Uematsu
authors.forename: Ban
authors.initials: B
authors.lastname: Mihara
authors.forename: Yoko
authors.initials: Y
authors.lastname: Morita
authors.forename: Kazuo
authors.initials: K
authors.lastname: Isozumi
authors.forename: Kouichi
authors.initials: K
authors.lastname: Ohta
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Muramatsu
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Shirai
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nogawa
authors.forename: Jun
authors.initials: J
authors.lastname: Gotoh
authors.forename: Keiji
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tomita
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yasutomi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nihei
authors.forename: Satoko
authors.initials: S
authors.lastname: Iwasawa
authors.forename: Norihiro
authors.initials: N
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D003430:Cross-Sectional Studies / Q000379:methods; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009069:Movement Disorders / Q000188:drug therapy*; D010300:Parkinson Disease / Q000188:drug therapy* / Q000523:psychology*; D011795:Surveys and Questionnaires / Q000592:standards
chemical_list: D007980:Levodopa