The Effect of Non-motor Symptoms on Quality of Life in Parkinson’s Disease
The Effect of Non-motor Symptoms on Quality of Life in Parkinson’s Disease
European Neurological Review, 2009;4(2):29-33
Abstract
Non-motor symptoms (NMS) are common in Parkinson’s disease (PD), affecting up to 90% of patients during their illness, and include neuropsychiatric complications, autonomic disorders, sleep disturbances and sensory symptoms. Although NMS correlate strongly with advancing disease, they may precede the onset of motor symptoms by a number of years. It is increasingly recognised that NMS result in a significant burden for people with PD and affect quality of life (QoL) to a greater extent than motor features. However, NMS often remain undiagnosed and untreated. Herein we review the impact of common NMS on QoL for patients with PD.
Keywords
Non-motor symptoms, Parkinson’s disease, quality of life, depression, anxiety, psychosis, cognitive impairment, sleep disorder, fatigue, autonomic dysfunction, sensory symptoms
Disclosure: Claire Hinnell receives salary support from an unrestricted educational grant from Solvay Pharmaceuticals to King’s College Hospital and has no conflicts of interest to declare. K Ray Chaudhuri is a consultant and member of the advisory board and speaker’s bureau for GSK, Boehringer, Teva, Solvay, Britannia, UCB and Ipsen, and has received honoraria for international lectures from the same companies.
Received: 12 December 2009 Accepted: 22 January 2010
Correspondence: K Ray Chaudhuri, 9th Floor Ruskin Wing, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK. E: chaudhuriray@hotmail.com
Parkinson’s disease (PD) affects about 1–2% of the population over 65 years of age and up to 3–5% of people 85 years of age and older.1 As the average age of the population increases, the prevalence of PD can be expected to rise. There is increasing awareness that the non-motor symptoms (NMS) of PD significantly contribute to the overall burden of the disease, which determines quality of life (QoL). With this in mind, it is essential to optimise the management of all aspects of PD. NMS (see Table 1) include neuropsychiatriccomplications, autonomic disorders, sleep disturbances and sensory symptoms. NMS affect the majority of patients during their illnessand, although NMS correlate strongly with advancing disease, they may precede the onset of motor symptoms by a number of years.2–5 It is increasingly recognised that NMS create a significant burden for people with PD and affect QoL to a greater extent than motor features.6–14 Without careful attention, NMS may remain undiagnosed and untreated. A recent international survey showed that up to 62% of NMS in PD might remain undeclared to healthcare professionals because patients are either embarrassed or unaware that their symptoms are linked to PD.15 Using a screening tool can help to identify the problem. For example, in a study using the NMS Questionnaire (NMSQ), PD patients reported nine to 12 different NMSin their clinic visit, many of which had not been discussed with the doctor before being flagged by the NMSQ.16
Scale and Impact of the Problem of Non-motor Symptoms in Parkinson’s Disease
NMS occur in up to 90% of patients with PD during their disease course.5 Shulman et al. studied 99 patients with PD without dementia and reported that over half had at least two NMS and 25% had more than three.5 In a more recent study of 49 patients with PD, McKinlay et al. found that 77% reached the cut-off for one or more NMS, while 46% had three or more.10 The PRIAMO study of 1,072 consecutive patients with PD found that 98.6% of patients reported at least one NMS.6 The frequency of NMS increased with disease severity, and patients with cognitive impairment had more NMS than those without. In the latest validation study of the Non-Motor Symptoms Scale (NMSS) in PD, only two of 411 patients reported no NMS.17 The same study suggested that there is a close and robust correlation between the overall burden of NMS, measured by the NMSS composite score, and QoL, measured by the Parkinson’s Disease Questionnaire (PDQ-39). The correlation value (Spearman r=0.7) was stronger than the correlation between QoL and motor state. This study is one of the first to establish the close link between NMS and QoL in a statistical manner in an international study spanning PD patients across all disease stages.17 Our review focuses on the impact of common NMS on QoL for patients with PD.
To View full article : register here
Non-motor symptoms, Parkinson’s disease, quality of life, depression, anxiety, psychosis, cognitive impairment, sleep disorder, fatigue, autonomic dysfunction, sensory symptoms, treatment Parkinson’s disease, Parkinson’s disease symptoms,
