Nonmotor fluctuations in Parkinson disease

Objective: To evaluate frequency, severity, and correlation of nonmotor symptoms (NMS) with motor complications in fluctuating Parkinson disease (PD).

Methods: The Multicenter NonMotor Fluctuations in PD cross-sectional study used clinical examination of 10 NMS (dysphagia, anxiety, depression, fatigue, excessive sweating, inner restlessness, pain, concentration/attention, dizziness, bladder urgency) quantified using a visual analogue scale (VAS) in motor-defined on (NMS_On) and off state (NMS_Off) combined with motor assessments and self-ratings at home in 100 patients with advanced PD.

Results: All NMS except dysphagia, excessive sweating, and bladder urgency fluctuated in conjunction to motor fluctuations with more frequent and severe symptoms in off compared to on state. The proportions of patients experiencing autonomic/sensory NMS in both motor states were similar to those with these NMS exclusively in off state (ratios 0.4–1.3), while for mental/psychic NMS the proportions with exclusive manifestation in off state were higher (ratios 1.8–3.1). Demographic and clinical characteristics correlated neither with NMS frequency patterns and severities nor with ΔNMS_On/Off severities (defined as the differences of VAS scores between on and off). Severities of NMS_on, NMS_Off, and ΔNMS_On/Off did not correlate with motor function. Presence of anxiety, depression, fatigue, and pain had negative impact on health-related quality of life (HRQOL) measured by Parkinson's Disease Questionnaire–8 scoring independent of their occurrence with respect to motor state. Fluctuations of these NMS but not of fatigue deteriorated HRQOL.

Conclusion: Patterns of NMS fluctuations are heterogeneous and complex, but psychic NMS fluctuate more frequently and severely. Demographic parameters and motor function do not correlate with NMS or nonmotor fluctuation severities in fluctuating PD.