Symptom Networks and Associations with Quality of Life in Patients with Early to Mid-Stage Parkinson's Disease: A Network Analysis.

Abstract

Purpose: The symptoms of patients with early to mid-stage Parkinson's disease (PD) are closely associated with their quality of life. However, few studies have explored the relationship between symptoms and quality of life. This study aims to investigate the symptom profiles of patients with early to mid-stage PD, construct a symptom network to identify core symptoms, and examine their associations with quality of life.

Patients and methods: This cross-sectional study was conducted from November 2024 to February 2025 among 954 patients with early to mid-stage PD in China, with stages 1-2 classified as early stage and stage 3 as mid stage. All participants completed the PD Symptom Experience Scale. Network models were constructed using R version 4.4.3 to identify core symptoms, describe inter-symptom relationships, and calculate centrality indices.

Results: The top three symptoms in terms of prevalence were bradykinesia (77.46%), resting tremor (75.05%), and rigidity (59.01%). The most severe symptom was resting tremor. In the symptom network analysis, the top three symptoms with the highest node centrality were bradykinesia (r_e=1.27), postural instability (r_e=1.16), and limb stiffness (r_e=1.96). In the quality of life network, the dimensions with the highest node centrality were "mobility" (r_be=0.52), "emotional well-being" (r_be=0.50), and "cognitions" (r_be=0.49). "Mobility" was positively correlated with difficulty turning over in bed (r=0.19), freezing of gait (r=0.09), and difficulty standing up or sitting down (r=0.08).

Conclusion: Multiple symptoms were simultaneously experienced by patients with early to mid-stage PD, and interrelationships among symptoms were observed. Bradykinesia was identified as the core symptom, and the "mobility" dimension was recognized as the central node in the quality of life network. Healthcare providers are advised to comprehensively consider patients' overall symptom profiles and their relationships with quality of life, and to implement targeted, integrated interventions.