Clinical Spectrum of Non-motor Symptoms in Correlation with Quality of Life in Parkinson's Disease and Atypical Parkinsonism: Evidence in Reaching Consensus.

Abstract

Background: Non-motor symptoms (NMS) are frequently overlooked, yet they significantly contribute to the progression of Parkinson's disease (PD) or atypical parkinsonism (AP), which include multiple system atrophy (MSA), progressive supranuclear palsy (PSP). Moreover, discrepancies exist in non-motor symptom scale (NMSS) scores for AP and PD, and no consensus has yet been reached.

Purpose: We evaluated and compared the NMS and their association with life quality in patients with AP and PD.

Methods: This cross-sectional observational report at a single-centre enrolling 204 patients (155 PD, 49 AP (27 MSA), and 22 PSP) from a tertiary care hospital's movement disorder clinic. We used Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS UPDRS)-III and modified Hoehn and Yahr (H&Y) to compute a motor score and disease severity, respectively. We assessed patients' mental capabilities, such as cognitive impairment, through a Mini-Mental State Examination (MMSE). Meanwhile, the NMSS determined the NMSs. Quality of life (QoL) was estimated by PD Questionnaire-39 (PDQ-39).

Results: We observed insignificant differences between the PD and atypical parkinsonian syndrome (APS) groups based on disease duration and gender. Worsened motor disability and disease severity were observed in AP (PSP>MSA) (P < .001). The mean NMSS scores for PD, PSP and MSA were 23.7 ± 27.9, 47.6 ± 41.3 and 65.6 ± 35.5, respectively (P < .05). MSA had a comparatively high score for sexual, cardiovascular and urinary domains, while PSP scored higher for memory/attention domains. In contrast, PD group revealed significantly lower scores for perceptual and sexual domains.

Conclusion: Compared to PD, NMS was severe and highly prevalent among AP (MSA > PSP), which could be confirmed through the prevalence of sexual cardiovascular and urinary domains in MSA, while attention and mood/cognition, and sleep in PSP.