Nonmotor fluctuations in Parkinson disease: severity and correlation with motor complications.
OBJECTIVE
To evaluate frequency, severity, and correlation of nonmotor symptoms (NMS) with motor complications in fluctuating Parkinson disease (PD).


METHODS
The Multicenter NonMotor Fluctuations in PD cross-sectional study used clinical examination of 10 NMS (dysphagia, anxiety, depression, fatigue, excessive sweating, inner restlessness, pain, concentration/attention, dizziness, bladder urgency) quantified using a visual analogue scale (VAS) in motor-defined on (NMS(On)) and off state (NMS(Off)) combined with motor assessments and self-ratings at home in 100 patients with advanced PD.


RESULTS
All NMS except dysphagia, excessive sweating, and bladder urgency fluctuated in conjunction to motor fluctuations with more frequent and severe symptoms in off compared to on state. The proportions of patients experiencing autonomic/sensory NMS in both motor states were similar to those with these NMS exclusively in off state (ratios 0.4-1.3), while for mental/psychic NMS the proportions with exclusive manifestation in off state were higher (ratios 1.8-3.1). Demographic and clinical characteristics correlated neither with NMS frequency patterns and severities nor with ΔNMS(On/Off) severities (defined as the differences of VAS scores between on and off). Severities of NMS(on), NMS(Off), and ΔNMS(On/Off) did not correlate with motor function. Presence of anxiety, depression, fatigue, and pain had negative impact on health-related quality of life (HRQOL) measured by Parkinson's Disease Questionnaire-8 scoring independent of their occurrence with respect to motor state. Fluctuations of these NMS but not of fatigue deteriorated HRQOL.


CONCLUSIONS
Patterns of NMS fluctuations are heterogeneous and complex, but psychic NMS fluctuate more frequently and severely. Demographic parameters and motor function do not correlate with NMS or nonmotor fluctuation severities in fluctuating PD.
Department of Neurology, Division of Neurodegenerative Diseases, Dresden University of Technology, Dresden. alexander.storch@neuro.med.tu-dresden.de
Alexander
A
Storch
Christine B
CB
Schneider
Martin
M
Wolz
Yannic
Y
Stürwald
Angelika
A
Nebe
Per
P
Odin
Andreas
A
Mahler
Gerd
G
Fuchs
Wolfgang H
WH
Jost
K Ray
KR
Chaudhuri
Rainer
R
Koch
Heinz
H
Reichmann
Georg
G
Ebersbach
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000503:physiopathology*; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D009069:Movement Disorders / Q000209:etiology / Q000503:physiopathology*; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology*; D012720:Severity of Illness Index