Associations between Severity of Motor Function and Nonmotor Symptoms in Parkinson's Disease: A Post Hoc Analysis of the RECOVER Study

Abstract

Background: RECOVER (NCT00474058), a double-blind, placebo-controlled trial in patients with Parkinson's disease (PD) and unsatisfactory early-morning motor symptom control, demonstrated significant improvements with rotigotine in early-morning motor function (Unified Parkinson's Disease Rating Scale [UPDRS] III), and nocturnal sleep disturbances (modified Parkinson's Disease Sleep Scale [PDSS-2]), and improvements in nonmotor symptoms (NMS; Non-Motor Symptom Scale [NMSS]). Methods: Post hoc analyses investigated the correlation between motor symptom and NMS severity in PD by evaluating associations between UPDRS III and both NMSS and PDSS-2 scores. Categories were defined for UPDRS III, NMSS, and PDSS-2 total scores; analyses were conducted for the full analysis set (n = 267). Results: There was a trend toward increasing PDSS-2 and NMSS total and domain scores with increasing UPDRS III category at baseline and end of maintenance (EoM). Pearson correlation coefficients between UPDRS III and both NMSS and PDSS-2 total and domain scores were r = 0.12-0.44 (r² = 0.01-0.19) at baseline, r = 0.05-0.38 (r² = 0.00-0.14) at EoM, and r = -0.02-0.36 (r² = 0.00-0.13) for change from baseline to EoM. Conclusion: There was only a small correlation between severity of early-morning motor symptoms and overall burden of NMS and nocturnal sleep disturbances in RECOVER, suggesting that motor symptoms and NMS originate, at least partly, from distinct pathophysiological pathways.

Characterizing motor and non-motor aspects of early-morning off periods in Parkinson's disease: An international multicenter study

“…In some but not all cases, off states during waking day or evening were not necessarily associated with these NMS, suggesting that in some aspects of NMS of EMO are unique to the morning time. This observation is supported by a recent post hoc analysis of the RECOVER study data where a poor correlation with severity of EMO and overall burden of NMS was reported [22].…”

Burden of non‐motor symptoms in Parkinson's disease patients predicts improvement in quality of life during treatment with levodopa‐carbidopa intestinal gel

“…The analysis of the GLORIA database included assessments of motor and non‐motor symptoms and QoL with results comparable to a number of recent studies . The results of this first, large multinational, long‐term registry demonstrated sustained improvements with LCIG of motor and non‐motor symptoms and in NMSS subdomains (particularly sleep/fatigue, mood/cognition and gastrointestinal domains), as well as QoL in advanced PD patients at 12 and 24 months .…”

“…The analysis of the GLORIA database included assessments of motor and non-motor symptoms and QoL with results comparable to a number of recent studies [11,[15][16][17][18]20,22,24]. The results of this first, Table 1 Demographics and baseline disease characteristics in patients allocated to one of the five baseline NMSB categories defined by the NMSS total score cut-off scores 0-20 (N = 28), 21- large multinational, long-term registry demonstrated sustained improvements with LCIG of motor and non-motor symptoms and in NMSS subdomains (particularly sleep/fatigue, mood/cognition and gastrointestinal domains), as well as QoL in advanced PD patients at 12 and 24 months [25,26].…”

Effects of Rotigotine on REM Sleep Behavior Disorder in Parkinson Disease

“…It cannot be excluded that the improvement in RBD symptoms may be associated with improved patient PD motor symptoms, mobility at bedtime, and attenuation of dystonia or pain in specific patients, which have been demonstrated as therapeutic effects of rotigotine in other previous studies. 10,39 Although not significant, the decrease in REM duration may have contributed to the reduced behavioral manifestations of RBD after rotigotine treatment. Therefore, this study is only a preliminary exploration.…”