Non-Motor Symptoms in Treated and Untreated Chinese Patients with Early Parkinson’s Disease

Abstract

Non-motor symptoms (NMS) are important preclinical features of Parkinson's disease (PD) and have become the leading cause of poor quality of life with disease progression. There are little data on how antiparkinsonian medications influence the NMS in PD at early stage. In this study, we explored the distribution of NMS in treated and untreated PD and investigated the association between NMS and antiparkinsonian medications in Chinese patients with early PD. Subjects were enrolled from a Chinese PD patient cohort based on 2 clinical trials. Face-to-face interviews and evaluations were performed for clinical information. NMS were compared in patients with or without antiparkinsonian treatment, and between subgroups of dopaminergic medications. Eight hundred and sixteen PD patients were enrolled in this study, of whom 428 were newly diagnosed PD. Only 5 in 646 patients who completed all these NMS measurements (0.6%) were free of NMS. PD patients with antiparkinsonian medications had a significantly higher frequency of poor sleep (p = 0.001), depression (p = 0.0001) and constipation (p = 0.0001) after adjusted gender, onset age, duration, and Hoehn & Yahr stage. Moreover, patients treated by levodopa plus dopamine agonist had a higher percentage of bad sleepers (adjusted p = 0.040), and correlation analysis revealed that Levodopa Equivalent Dose (LED) was associated with constipation (coefficient 0.146, p = 0.005). These findings suggest that although NMS exist in the prodromal stage of PD, antiparkinsonian treatment is associated with increased frequency of some NMS, which may challenge the management for PD.

The range and nature of non-motor symptoms in drug-naive Parkinson’s disease patients: a state-of-the-art systematic review

“…17 A holistic analysis of the NMS spectrum in the latter study population showed that 71% of the patients report fatigue, 59% of the patients were having sleep problems, 36% of the patients suffered from constipation, and 32% of the patients suffered from depression. 18 However, in this study, the authors did not use a single holistic NMS tool, but other specific questionnaires such as the 20-item version of the Center for Epidemiological Studies Depression Scales (CES-D) for depression and the MMSE and Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) for cognition.…”

Neuropsychiatric symptoms in untreated Parkinson’s disease

“…Other studies that have evaluated the prevalence of the various sleep disorders in PD patients reported a wide range of prevalence because of different methods used and different PD stage examinations 157–163. A recent study exploring the distribution of sleep quality in untreated PD patients with motor symptoms found that 59.2% of the patients had sleep disturbances and the percentage was even higher in patients treated with DRT 164. In premotor untreated PD, according to studies, the prevalence of sleep disturbances was 17%–52% 37,38…”

“…In general, patients with dopaminergic therapy are more likely to be bad sleepers, depressed, and with cognitive impairment compared to untreated patients 164,187,188. In addition, initiation of DRT is associated with an increase in ICD symptoms, psychosis, and excessive daytime sleepiness.…”

Delineating nonmotor symptoms in early Parkinson's disease and first‐degree relatives

“…Crucially, despite these symptoms being manageable and often treatable, they are frequently unrecognized and undertreated in the clinical setting . Changes in severity of NMS are reported with the use of medication and specific motor subtypes, with important implications for treatment and underlying pathophysiology …”

“…3 Crucially, despite these symptoms being manageable and often treatable, they are frequently unrecognized and undertreated in the clinical setting. 4 Changes in severity of NMS are reported with the use of medication 5 Relevant conflicts of interest/financial disclosures: Nothing to report. Full financial disclosures and author roles may be found in the online version of this article.…”