title: A longitudinal study of non-motor symptom burden in Parkinson's disease after a transition to expert care.
abstract: BACKGROUND
  Non-motor symptoms (NMS) are common among patients with Parkinson's disease (PD) however little is known about their progression in terms of severity or burden after referral to expert care.
  
  
  OBJECTIVE
  This study was aimed to establish the progression of NMS burden in PD patients after referral to tertiary healthcare centre and factors affecting it.
  
  
  METHODS
  Newly referred PD patients were prospectively enrolled and follow-up for up to 18 months. Non-motor symptoms scale (NMSS) was used to evaluate the burden of non-motor symptoms.
  
  
  RESULTS
  There was a significant median reduction of total NMS burden over the follow-up period. Similarly all NMS domains except domains 2 (sleep/fatigue), 3 (mood/cognition), 6 (gastrointestinal) and 7 (urinary) showed significant median reduction of scores. In the univariate regression analysis, Hoehn & Yahr staging, disease duration, visit, Schwab & England Activities of Daily Living score and UPDRS motor scores were individually predictive of change in total NMS burden. However, in the multivariable regression analysis only the latter three were significantly predictive of change in the total NMS burden.
  
  
  CONCLUSIONS
  There was a significant reduction of total NMS burden over the study period. The severity of motor and activity of daily living impairments as well as subsequent visit were the best predictors of NMS change.
authors.affiliation: Department of Neurology, Singapore; Singapore General Hospital, Singapore; National Neuroscience Institute, Singapore; Duke-NUS Graduate Medical School, Singapore. Electronic address: gnrpk@sgh.com.sg.
authors.forename: Kumar M
authors.initials: KM
authors.lastname: Prakash
authors.affiliation: Centre for Quantitative Medicine, Singapore; Duke-NUS Graduate Medical School, Singapore.
authors.forename: Nivedita V
authors.initials: NV
authors.lastname: Nadkarni
authors.affiliation: Centre for Quantitative Medicine, Singapore; Duke-NUS Graduate Medical School, Singapore.
authors.forename: Weng-Kit
authors.initials: WK
authors.lastname: Lye
authors.affiliation: Department of Neurology, Singapore; Singapore General Hospital, Singapore.
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Yong
authors.affiliation: Department of Neurology, Singapore; Singapore General Hospital, Singapore; National Neuroscience Institute, Singapore.
authors.forename: Lai-Mun
authors.initials: LM
authors.lastname: Chew
authors.affiliation: Department of Neurology, Singapore; Singapore General Hospital, Singapore; National Neuroscience Institute, Singapore; Duke-NUS Graduate Medical School, Singapore.
authors.forename: Eng-King
authors.initials: EK
authors.lastname: Tan
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D012017:Referral and Consultation; D012720:Severity of Illness Index; D063128:Tertiary Health Care
keywords: Non-motor symptoms; Parkinson's disease