Neurological Sciences

, Volume 33, Issue 4, pp 847–853

Concordance between severity of disease, prevalence of nonmotor symptoms, patient-reported quality of life and disability and use of medication in Parkinson’s disease

  • Alberto Raggi
  • Matilde Leonardi
  • Venusia Covelli
  • Alberto Albanese
  • Paola Soliveri
  • Francesco Carella
  • Luigi Romito
Original Article


The aim of this study was to test the concordance between disease severity, prevalence of nonmotor symptoms, age, health-related quality of life (HRQoL), disability and medication use in patients with Parkinson’s disease (PD). Severity was classified with the Hoehn and Yahr (HY) scale and Levodopa Equivalent Daily Dose (LEDD) calculated. HRQoL was evaluated with the SF-36, disability with the WHO-DAS II and nonmotor symptoms with the NMSQuest. Patients were clustered using SF-36 and WHO-DAS II into three groups covering the continuum from low disability and HRQoL, to severe disability and HRQoL decrement. Contingency Coefficient were used to verify the relationships between clusters and HY stage; ANOVA to evaluate differences in NMS, age and LEDD between clusters; odds ratio to test the likelihood of taking levodopa or dopamine agonist and being member of the three clusters; t test to evaluate differences in LEDD between patients with HY ≥3 or ≤2. Eighty-six patients were clustered: 48 had low disability and HRQoL decrement, 18 intermediate disability and HRQoL decrement and 20 high disability and HRQoL decrement. A significant relationship was found between PD severity groups, HRQoL and disability profiles. No differences for age and LEDD were observed in the three groups, and those with more disability and lower HRQoL reported a higher number of nonmotor symptoms; patients in HY ≥3 were prescribed higher doses of drugs. In conclusion, we found a substantial concordance between PD staging, prevalence of nonmotor symptoms and patient-reported HRQoL and disability measures. In our opinion, the SF-36 and the WHO-DAS II can be used for profiling patients.


Disability Health-related quality of life Parkinson’s disease Nonmotor symptoms Levodopa equivalent daily dose LEDD 


  1. 1.
    de Lau LML, Breteler MMB (2006) Epidemiology of Parkinson’s disease. Lancet Neurol 5:525–535PubMedCrossRefGoogle Scholar
  2. 2.
    Jankovic J (2008) Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 79:368–376PubMedCrossRefGoogle Scholar
  3. 3.
    Gallagher DA, Lees AJ, Schrag A (2010) What are the most important nonmotor symptoms in patients with Parkinson’s disease and are we missing them? Mov Disord 25:2493–2500PubMedCrossRefGoogle Scholar
  4. 4.
    Chaudhuri KR, Prieto-Jurcynska C, Naidu Y, Mitra T, Frades-Payo B, Tluk S, Ruessmann A, Odin P, Macphee G, Stocchi F, Ondo W, Sethi K, Schapira AH, Martinez Castrillo JC, Martinez-Martin P (2010) The nondeclaration of nonmotor symptoms of Parkinson’s disease to health care professional: an international study using the Nonmotor Symptoms Questionnaire. Mov Disord 25:704–709PubMedCrossRefGoogle Scholar
  5. 5.
    Park A, Stacy M (2009) Non-motor symptoms in Parkinson’s disease. J Neurol 256:S293–S298CrossRefGoogle Scholar
  6. 6.
    Lees AJ, Hardy J, Revesz T (2009) Parkinson’s disease. Lancet 373:2055–2066PubMedCrossRefGoogle Scholar
  7. 7.
    Keus SH, Bloem BR, Hendriks EJ, Bredero-Cohen AB, Munneke M, Practice Recommendations Development Group (2007) Evidence-based analysis of physical therapy in Parkinson’s disease with recommendations for practice and research. Mov Disord 22:451–460PubMedCrossRefGoogle Scholar
  8. 8.
    Winter Y, von Campenhausen S, Arend M, Longo K, Boetzel K, Eggert K, Oertel WH, Dodel R, Barone P (2011) Health-related quality of life and its determinants in Parkinson’s disease: results of an Italian cohort study. Parkinsonism Relat Disord 17:265–269PubMedCrossRefGoogle Scholar
  9. 9.
    Post B, Muslimovic D, van Geloven N, Speelman JD, Schmand B, de Haan RJ, on behalf of the CARPA-study group (2011) Progression and prognostic factors of motor impairment, disability and quality of life in newly diagnosed Parkinson’s disease. Mov Disord 26:449–456PubMedCrossRefGoogle Scholar
  10. 10.
    Duncan RP, Earhart GM (2011) Measuring participation in individuals with Parkinson disease: relationships with disease severity, quality of life, and mobility. Disabil Rehabil 33:1440–1446PubMedCrossRefGoogle Scholar
  11. 11.
    Muslimovic D, Post B, Speelman JD, Schmand B, de Haan RJ, CARP A-study group (2008) Determinants of disability and quality of life in mild to moderate Parkinson disease. Neurology 3:2241–2247CrossRefGoogle Scholar
  12. 12.
    Gomez-Esteban JC, Zarranz JJ, Lezcano E, Tijero B, Luna A, Velasco F, Rouco I, Garamendi I (2007) Influence of motor symptoms upon the quality of life of patients with Parkinson’s disease. Eur Neurol 57:161–165PubMedCrossRefGoogle Scholar
  13. 13.
    Gomez-Esteban JC, Tijero B, Somme J, Ciordia R, Berganzo K, Rouco I, Bustos JL, Valle MA, Lezcano E, Zarranz JJ (2011) Impact of psychiatric symptoms and sleep disorders on the quality of life of patients with Parkinson’s disease. J Neurol 258:494–499PubMedCrossRefGoogle Scholar
  14. 14.
    Weintraub D, Moberg PJ, Duda JE, Katz IR, Stern MB (2004) Effect of psychiatric and other nonmotor symptoms on disability in Parkinson’s Disease. J Am Geriatr Soc 52:784–788PubMedCrossRefGoogle Scholar
  15. 15.
    Shulman LM, Gruber-Baldini AL, Andreson KE, Vaughan CG, Reich SG, Fishman PS, Weiner WJ (2008) The evolution of disability in Parkinson disease. Mov Disord 23:790–796PubMedCrossRefGoogle Scholar
  16. 16.
    Soh SE, Morris ME, McGinley JL (2011) Determinants of health-related quality of life in Parkinson’s disease: a systematic review. Parkinsonism Relat Disord 17:1–9PubMedCrossRefGoogle Scholar
  17. 17.
    Winter Y, von Campenhausen S, Gasser J, Seppi K, Reese JP, Pfeiffer KP, Bötzel K, Oertel WH, Dodel R, Poewe W (2010) Social and clinical determinants of quality of life in Parkinson’s disease in Austria: a cohort study. J Neurol 257:638–645PubMedCrossRefGoogle Scholar
  18. 18.
    Ware JE (2000) SF-36 health survey update. Spine 25:3130–3139PubMedCrossRefGoogle Scholar
  19. 19.
    Peto V, Jenkinson C, Fitzpatrick R (1998) PDQ-39: a review of the development, validation and application of a Parkinson’s disease quality of life questionnaire and its associated measures. J Neurol 245:S10–S14PubMedCrossRefGoogle Scholar
  20. 20.
    Tanji H, Gruber-Baldini AL, Anderson KE, Pretzer-Aboff I, Reich SG, Fishman PS, Weiner WJ, Shulman LM (2008) A comparative study of physical performance measures in Parkinson’s disease. Mov Disord 23:1897–1905PubMedCrossRefGoogle Scholar
  21. 21.
    Fahn S, Elton RL (1987) Unified Parkinson’s disease rating scale. In: Fahn S, Marsden CD, Calne D, Golstein N (eds) Recent developments in Parkinson’s disease. MacMillan Health Care Information, Florham Park, pp 153–163Google Scholar
  22. 22.
    Schwab RS, England AC (1968) Projection technique for evaluating surgery in Parkinson’s disease. In: Gillingham FJ, Donaldson IMI (eds) Third symposium on surgery in Parkinson’s disease. Livingstone, Edinburg, pp 152–157Google Scholar
  23. 23.
    World Health Organisation (2001) The international classification of functioning, disability and health-ICF. World Health Organisation, GenevaGoogle Scholar
  24. 24.
    Fratiglioni L, Wang HX, Ericsson K, Maytan M, Winbald B (2000) Influence of social network on occurrence of dementia: a community-based longitudinal study. Lancet 355:1315–1319PubMedCrossRefGoogle Scholar
  25. 25.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184PubMedCrossRefGoogle Scholar
  26. 26.
    Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442PubMedCrossRefGoogle Scholar
  27. 27.
    Martinez-Martin P, Schapira AHV, Stocchi F, Sethi K, Odin P, MacPhee G, Brown RG, Naidu Y, Clayton L, Abe K, Tsuboi Y, MacMahon D, Barone P, Rabey M, Bonuccelli U, Forbes A, Breen K, Tluk S, Olanow CW, Thomas S, Rye D, Hand A, Williams AJ, Ondo W, Chaudhuri KR (2007) Prevalence of nonmotor symptoms in Parkinson’s disease in an International setting; study using nonmotor symptoms questionnaire in 545 patients. Mov Disord 22:1623–1629PubMedCrossRefGoogle Scholar
  28. 28.
    Ustün TB, Chatterji S, Kostanjsek N, Rehm J, Kennedy C, Epping-Jordan J, Saxena S, von Korff M, Pull C, WHO/NIH Joint Project (2010) Developing the World Health Organization Disability Assessment Schedule 2.0. Bull World Health Organ 88:815–823PubMedCrossRefGoogle Scholar
  29. 29.
    Garin O, Ayuso-Mateos JL, Almansa J, Nieto M, Chatterji S, Vilagut G, Alonso J, Cieza A, Svetskova O, Burger H, Racca V, Francescutti C, Vieta E, Kostanjsek N, Raggi A, Leonardi M, Ferrer M, MHAD IE consortium (2010) Validation of the World Health Organization Disability Assessment Schedule (WHODAS-2) in patients with chronic diseases. Health Qual Life Outcomes 8:51PubMedCrossRefGoogle Scholar
  30. 30.
    Ware JE (2000) SF-36 health survey update. Spine 25:3130–3139PubMedCrossRefGoogle Scholar
  31. 31.
    Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 25:2649–2653PubMedCrossRefGoogle Scholar
  32. 32.
    Martinez-Martin P, Rodriguez-Blazquez C, Kurtis MM, Chaudhuri KR, on Behalf of the NMSS Validation Group (2011) The impact of non-motor symptoms on health-related quality of life of patients with Parkinson’s disease. Mov Disord 26:399–406PubMedCrossRefGoogle Scholar
  33. 33.
    Hu M, Cooper J, Beamish R, Jones E, Butterworth R, Catterall L, Ben-Shlomo Y (2011) How well do we recognise non-motor symptoms in a British Parkinson’s disease population? J Neurol 258:1513–1517PubMedCrossRefGoogle Scholar
  34. 34.
    Leonardi M, Raggi A, Antozzi C, Confalonieri P, Maggi L, Cornelio F, Mantegazza R (2010) The relationship between health, disability and quality of life in Myasthenia Gravis: results from an Italian study. J Neurol 257:98–102PubMedCrossRefGoogle Scholar
  35. 35.
    Leonardi M, Raggi A, Bussone G, D’Amico D (2010) Health-related quality of life, disability and severity of disease in patients with migraine attending to a specialty headache center. Headache 50:1576–1586PubMedCrossRefGoogle Scholar
  36. 36.
    Raggi A, Leonardi M, Antozzi C, Confalonieri P, Maggi L, Cornelio F, Mantegazza R (2010) Concordance between severity of disease, disability and health-related quality of life in Myasthenia gravis. Neurol Sci 31:41–45PubMedCrossRefGoogle Scholar
  37. 37.
    Raggi A, Leonardi M, Bussone G, D’Amico D (2011) Value and utility of disease-specific and generic instruments for assessing disability in patients with migraine, and their relationships with health-related quality of life. Neurol Sci 32:387–392PubMedCrossRefGoogle Scholar
  38. 38.
    Leonardi M, Raggi A, Pagani M, Carella F, Soliveri P, Albanese A, Romito L (2011) Relationships between disability, quality of life and prevalence of nonmotor symptoms in Parkinson’s disease. Parkinsonism Relat Disord. doi:10.1016/j.parkreldis.2011.08.011
  39. 39.
    Rascol O, Brooks DJ, Korczyn AD, De Deyn PP, Clarke CE, Lang AE (2000) A five-year study of the incidence of dyskinesia in patients with early Parkinson’s disease who were treated with ropinirole or levodopa. 056 Study Group. N Engl J Med 342:1484–1491PubMedCrossRefGoogle Scholar
  40. 40.
    Parkinson Study Group (2000) Pramipexole vs levodopa as initial treatment of Parkinson’s disease: a randomised controlled trial. Parkinson Study Group. JAMA 284:1931–1938CrossRefGoogle Scholar
  41. 41.
    Oertel WH, Wolters E, Sampaio C, Gimenez-Roldan S, Bergamasco B, Dujardin M, Grosset DG, Arnold G, Leenders KL, Hundemer HP, Lledó A, Wood A, Frewer P, Schwarz J (2006) Pergolide versus levodopa monotherapy in early Parkinson’s disease patients: the PELMOPET study. Mov Disord 21:343–353PubMedCrossRefGoogle Scholar
  42. 42.
    Brown CA, Cheng EM, Hays RD, Vassar SD, Vickrey BG (2009) SF-36 includes less Parkinson disease (PD)-targeted content but is more responsive to change than two PD-targeted health-related quality of life measures. Qual Life Res 18:1219–1237PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Alberto Raggi
    • 1
  • Matilde Leonardi
    • 1
  • Venusia Covelli
    • 1
  • Alberto Albanese
    • 2
    • 3
  • Paola Soliveri
    • 2
  • Francesco Carella
    • 2
  • Luigi Romito
    • 2
    • 3
  1. 1.Neurology, Public Health and Disability Unit–Scientific Directorate, Neurological Institute C. BestaIRCCS FoundationMilanItaly
  2. 2.Department of Movement Disorders, Neurological Institute C. BestaIRCCS FoundationMilanItaly
  3. 3.Università Cattolica del Sacro CuoreMilanItaly

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