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Quantitative assessment of non-motor fluctuations in Parkinson’s disease using the Non-Motor Symptoms Scale (NMSS)

  • Neurology and Preclinical Neurological Studies - Original Article
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Abstract

Data on frequency, severity and correlations of NMS with motor complications are only available for a limited number of NMS. The NMS Scale (NMSS) is a validated tool to assess a broad range of NMS, which has not been used in NMS fluctuations. We assessed fluctuations of a broad range of non-motor symptom (NMS) for a 1-month time period in fluctuating Parkinson’s disease (PD) in a multicenter cross-sectional study using the NMSS assessing NMS in motor On (NMSSOn) and Off state (NMSSOff) combined with clinical NMS and motor function scoring in 100 fluctuating PD patients. ΔNMSSOn/Off was defined as the differences of NMSS scores between On and Off. Complete NMSS datasets were available from 73 patients (53 % men; age: 68.2 ± 9.7 years) with mean total NMSS score in On state of 41.5 ± 37.6 and in Off state of 75.6 ± 42.3 (P < 0.001). Scores were higher in Off compared to On state for all domains except for domain “perceptual problems/hallucinations” (P = 0.608). Clinimetric properties of the NMSS were similar to those reported previously for NMS assessments independent of motor oscillations. NMSSOn, NMSSOff and ΔNMSSOn/Off showed weak to moderate correlations with demographics, indicators of motor symptom severity as well as with other measures of NMS, depression and quality of life. Correlations of NMSS items/domains with independent measures of related constructs were weak to moderate. In conclusion, when assessed with the NMSS, a broad range of NMS fluctuate with motor oscillations, but these fluctuations do neither correlate with motor function nor with measures of disease progression.

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Acknowledgments

We acknowledge all collaborators of the NoMoFlu-PD study group and the international Parkinson’s disease non motor group who have contributed to the concept of this work. The NoMoFlu-PD Study Group consists of the following structure: NoMoFlu PD steering committee K. Ray Chaudhuri, National Parkinson Foundation Centre of Excellence, Kings College Hospital and Kings College London and Biomedical Research Centre, Kings College London, UK; Georg Ebersbach, Movement Disorders Clinic, Beelitz-Heilstätten, Germany; Gerd Fuchs, Parkinson Clinic Wolfach, Wolfach, Germany; Wolfgang H. Jost, Department of Neurology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany; Per Odin, Department of Neurology, Klinikum Bremerhaven, Bermerhaven, Germany; Alexander Storch, Division of Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, and German Centre for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany. Participating centers and investigators Division of Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, and German Centre for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany (Drs. Storch, Schneider, Wolz, Klingelhöfer, Fauser, Reichmann, Melzer, Stürwald, Schmidt [study nurse], A. Wolz [study nurse], C. Bosredon [study nurse]); Movement Disorders Clinic, Beelitz-Heilstätten, Germany (Drs. Nebe, Ebersbach); Department of Neurology, Klinikum Bremerhaven, Bremerhaven, Germany (Gies, Drs. Odin, Mahler); Parkinson Clinic Wolfach, Wolfach, Germany (Dr. Fuchs); Department of Neurology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany (Dr. Jost). Statistical analysis Dr. Koch (Department of Biometrics and Medical Informatics, Dresden University of Technology); Drs. Storch, Schneider (Division of Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden). Drs. Storch, Schneider and Koch had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Author notes

  1. Alexander Storch

    Present address: Department of Neurology, University of Rostock, 18147, Rostock, Germany

Authors and Affiliations

  1. Division of Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany

    Alexander Storch, Christine B. Schneider & Lisa Klingelhöfer

  2. German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307, Dresden, Germany

    Alexander Storch

  3. Department of Neurology, Klinikum Bremerhaven, 27574, Bremerhaven, Germany

    Per Odin

  4. Department of Neurology, Skane University Hospital, 221 85, Lund, Sweden

    Per Odin

  5. Parkinson Clinic Wolfach, 77709, Wolfach, Germany

    Gerd Fuchs

  6. Department of Neurology, Deutsche Klinik für Diagnostik, 65191, Wiesbaden, Germany

    Wolfgang H. Jost

  7. Research Unit, Alzheimer Center Reina Sofia Foundation and CIBERNED, Carlos III Institute of Health, 28031, Madrid, Spain

    Pablo Martinez-Martin

  8. Department of Medical Informatics and Biometry, Technische Universität Dresden, 01307, Dresden, Germany

    Rainer Koch

  9. Department of Neurology, Technische Universität Dresden, 01307, Dresden, Germany

    Heinz Reichmann

  10. National Parkinson Foundation Centre of Excellence, Kings College Hospital and Kings College London and Biomedical Research Centre, Kings College London, London, UK

    K. Ray Chaudhuri

  11. Movement Disorders Clinic, 14547, Beelitz-Heilstätten, Germany

    Georg Ebersbach

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  1. Alexander Storch
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NoMoFlu-PD study group

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Correspondence to Alexander Storch.

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Conflict of interest

AS has received unrestricted research grants from Boehringer Ingelheim, TEVA and GKC, honoraria for presentations/lectures or advisory boards from Boehringer Ingelheim, AbbVie, TEVA, Archimedes, UCB Pharma, Orion, Novartis, Lundbeck, TEVA, MEDA, GSK, NeuroConsil, Desitin, and Mundipharma, and consultancy fees from Boehringer Ingelheim, Britannia, GKC Melbourne, Mundipharma. CBS, LK, PM-M and RK have nothing to disclose. PO has received honoraria for presentations/lectures or advisory boards from AbbVie, Britannia, UCB Pharma, Orion, TEVA, Biogen, and consultancy fees from AbbVie. GF and GE have received honoraria for presentations/lectures or advisory boards from Boehringer Ingelheim. WHJ has received honoraria for presentations/lectures or advisory boards from Boehringer Ingelheim, TEVA, Desitin, GSK. HR was acting on advisory boards and gave lectures and received research grants from Biogen, Bayer Health Care, Boehringer/Ingelheim, Cephalon, Desitin, GSK, Merck-Serono, Novartis, Orion, Pfizer, AbbVie, TEVA/Lundbeck, UCB Schwarz Pharma, and MEDA. KRC has received unrestricted research grants from Boehringer Ingelheim, UCB and AbbVie, honoraria for presentations/lectures or advisory boards from Boehringer Ingelheim, AbbVie, UCB Pharma, Britannia, Medtronic, GSK and Mundipharma, and consultancy fees from Boehringer Ingelheim, Britannia, AbbVie, GSK, Medtronic, UCB and Mundipharma.

Funding sources

This study was supported in part by an unrestricted research grant from Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany. The financial sponsors of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had the final responsibility for the decision to submit for publication.

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Storch, A., Schneider, C.B., Klingelhöfer, L. et al. Quantitative assessment of non-motor fluctuations in Parkinson’s disease using the Non-Motor Symptoms Scale (NMSS). J Neural Transm 122, 1673–1684 (2015). https://doi.org/10.1007/s00702-015-1437-x

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  • DOI: https://doi.org/10.1007/s00702-015-1437-x

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