Journal of Neurology

, Volume 259, Issue 12, pp 2621–2631

The progression of non-motor symptoms in Parkinson’s disease and their contribution to motor disability and quality of life

Authors

    • Department for Parkinson’s DiseaseIRCCS San Camillo
    • Centro ParkinsonIstituti Clinici di Perfezionamento
  • Paolo Barone
    • Dipartimento Scienze Neurologiche, Scuola Medica Salernitana, Centro ParkinsonUniversità di Salerno
    • IDC-Hermitage-Capodimonte
  • Roberto Marconi
    • Ospedale della Misericordia
  • Letterio Morgante
    • Dipartimento di Neuroscienze, Scienze Psichiatriche ed AnestesiologicheUniversità di Messina
  • Salvatore Zappulla
    • Ospedale Umberto I
  • Francesco Ernesto Pontieri
    • Ospedale Sant’Andrea, II Facoltà di Medicina e Chirurgia“Sapienza” Università di Roma
  • Silvia Ramat
    • Dip. Scienze Neurologiche e PsichiatricheDay Hospital
  • Maria Gabriella Ceravolo
    • Ospedale Umberto I
  • Giuseppe Meco
    • Dipartimento di Neurologia e Psichiatria e Centro di Ricerca per le Malattie Sociali (CIMS), Centro Parkinson“Sapienza” Università di Roma
  • Giulio Cicarelli
    • A.O.R.N. San Giuseppe Moscati
  • Massimo Pederzoli
    • Ospedale Civile
  • Michela Manfredi
    • Fondazione Poliambulanza
  • Roberto Ceravolo
    • Azienda Ospedaliero-Universitaria Pisana
  • Marco Mucchiut
    • Policlinico Universitario Udine
  • Giampiero Volpe
    • Presidio Ospedaliero S. Luca
  • Giovanni Abbruzzese
    • Università degli Studi di Genova
  • Edo Bottacchi
    • Ospedale Regionale
  • Luigi Bartolomei
    • Ospedale Civile San Bortolo
  • Giuseppe Ciacci
    • Policlinico Le Scotte
  • Antonino Cannas
    • Policlinico Universitario di Monserrato
  • Maria Giovanna Randisi
    • Azienda Ospedaliera S. Elia
  • Alfredo Petrone
    • Presidio Ospedaliero Annunziata
  • Mario Baratti
    • Ospedale Ramazzini
  • Vincenzo Toni
    • P.O. F. Ferrari
  • Giovanni Cossu
    • Azienda Ospedaliera G. Brotzu
  • Paolo Del Dotto
    • Ospedale Versilia
  • Anna Rita Bentivoglio
    • Università Cattolica S. Cuore Policlinico Gemelli
  • Michele Abrignani
    • Ospedale di Marsala ASP TP/2
  • Rossana Scala
    • Ospedale S. Maria Loreto Nuovo
  • Franco Pennisi
    • Ospedale di Castelvetrano
  • Rocco Quatrale
    • Ospedale Sant’Anna
    • Ospedale dell’Angelo ULS12 Veneziana
  • Rosa Maria Gaglio
    • Az. Osp. S.Giovanni di Dio
  • Alessandra Nicoletti
    • Policlinico Universitario
  • Michele Perini
    • Ospedale S. Antonio Abate Gallarate
  • Tania Avarello
    • O.R. Villa Sofia
  • Antonio Pisani
    • Università di Roma Tor Vergata
  • Augusto Scaglioni
    • Ospedale di Vaio
  • Paolo Emilio Martinelli
    • Dipartimento Scienze NeurologicheUniversità di Bologna
  • Francesco Iemolo
    • P.O. Guzzardi
  • Laura Ferigo
    • Ospedale Cattinara
    • Azienda Ospedaliero Universitaria Integrata Verona
  • Pasqualino Simone
    • Ospedale Casa Sollievo della Sofferenza
  • Paola Soliveri
    • Istituto Nazionale Neurologico C. Besta
  • Biagio Troianiello
    • Istituto Clinico Città di Brescia
  • Domenico Consoli
    • Ospedale G. Iazzolino
  • Alessandro Mauro
    • Istituto Scientifico San Giuseppe
  • Leonardo Lopiano
    • Università degli Studi di Torino
  • Giuseppe Nastasi
    • Az. Osp. Papardo
  • Carlo Colosimo
    • Policlinico Umberto IUniv. La Sapienza
Original Communication

DOI: 10.1007/s00415-012-6557-8

Cite this article as:
Antonini, A., Barone, P., Marconi, R. et al. J Neurol (2012) 259: 2621. doi:10.1007/s00415-012-6557-8

Abstract

Non-motor symptoms are gaining relevance in Parkinson’s disease (PD) management but little is known about their progression and contribution to deterioration of quality of life. We followed prospectively 707 PD patients (62 % males) for 2 years. We assessed non-motor symptoms referred to 12 different domains, each including 1–10 specific symptoms, as well as motor state (UPDRS), general cognition, and life quality. Hoehn & Yahr (H&Y) stage was used to categorize patient status (I–II mild; III moderate; IV–V severe). We found that individual non-motor symptoms had variable evolution over the 2-year follow-up with sleep, gastrointestinal, attention/memory and skin disturbances (hyperhidrosis and seborrhea) becoming more prevalent and psychiatric, cardiovascular, and respiratory disorders becoming less prevalent. Development of symptoms in the cardiovascular, apathy, urinary, psychiatric, and fatigue domains was associated with significant life-quality worsening (p < 0.0045, alpha with Bonferroni correction). During the observation period, 123 patients (17 %) worsened clinically while 584 were rated as stable. There was a fivefold greater increase in UPDRS motor score in worse compared with stable patients over 24 months (p < 0.0001 vs. baseline both in stable and worse group). The total number of reported non-motor symptoms increased over 24 months in patients with motor worsening compared to stable ones (p < 0.001). Thirty-nine patients died (3.4 % of patients evaluable at baseline) with mean age at death of 74 years. Deceased patients were older, had significantly higher H&Y stage and motor score, and reported a greater number of non-motor symptoms at baseline. In conclusion, overall non-motor symptom progression does not follow motor deterioration, is symptom-specific, and only development of specific domains negatively impacts quality of life. These results have consequences for drug studies targeting non-motor features.

Keywords

Parkinson’s diseaseNon-motor symptomsMortalityCognitionQuality of lifeMotor progression

Copyright information

© Springer-Verlag 2012