Oct. 3,2015
MONTREAL -- The nonmotor
manifestations of Parkinson's disease -- including GI and urinary
problems, cognitive decline, sleep difficulty, and pain -- pose a substantial
burden to patients, often being prominent before the motor problems develop, a
researcher said here.
In a retrospective audit of 517
patients, 23% were graded as having a severe nonmotor symptom burden even as
the Hoehn-Yahr scale of motor decline was moderate, at a median score of 2.4,
reported Elisaveta Sokolov, MBBS, of King's College in London.
Moreover, the nonmotor symptom
burden was very severe in 21% of patients, yet their Hoehn-Yahr scale
score was a median of 2.9, which is not considered advanced from a
motor perspective, Sokolov said at the World Parkinson
Congress here.
"These observations suggest
that even at relatively mild motor stages, the nonmotor symptom burden can be
great and can have a huge impact on patients' quality of life," she said.
"Parkinson's disease is no
longer considered a complex motor disorder characterized by extrapyramidal
symptoms, but a progressive multisystem or multiorgan disease with variegated
neurologic and nonmotor deficiencies," she explained.
Her research team has been
focusing on the nonmotor aspects of Parkinson's disease not only because of
their quality of life impact, but also because this can help elucidate the etiology of the disease
and identify potential targets for disease-modifying drug therapies.
Patients often report that
nonmotor manifestations are more disabling and less amenable to treatment than
some motor symptoms.
The current study was part of a
5-year longitudinal, naturalistic study of nonmotor symptoms and progression in
early and late disease; researchers also evaluated the relationship between
nonmotor manifestations and motor decline.
Patients in this analysis were
predominantly men, whose mean age was 68 and whose mean Hoehn-Yahr stage was 2,
which reflects bilateral involvement without impairment of balance.
The scale used in this study
ranged from grades 1 to 5, with grade 1 representing minimal functional
disability and 5 being confinement to a wheelchair or bed. Among the 517
patients in this cohort, only 1% were classified as having grade 1, or mild,
nonmotor symptoms, 30% were grade 2, or moderate, and 69% were grades 3/4,
representing severe and very severe involvement.
Among those with the grade 3/4
nonmotor symptoms, some patients had specific dominant endophenotypes,
featuring primarily sleep or fatigue problems.
Only a single patient had no
nonmotor symptoms at all, Sokolov noted.
As with motor
manifestations, many of the nonmotor symptoms are associated with Parkinson's
disease itself."However, recent evidence suggests that nonmotor symptoms
such as anxiety, tingling, coldness of
limbs, and unclear thinking may frequently occur before motor symptoms emerge,
highlighting the importance of their recognition in clinical
practice," she noted.
This study emphasizes
the importance of including assessments of nonmotor function in patients
with Parkinson's disease with the goal of implementing true holistic care of
the multi-morbid patient with the disease, she concluded.
The study was funded by the U.K.
National Institute of Health Research.
http://www.medpagetoday.com/MeetingCoverage/WPC/42039
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