A Cross‐Sectional Comprehensive Assessment of the Profile and Burden of Non‐motor Symptoms in Relation to Motor Phenotype in the Nigeria Parkinson Disease Registry Cohort

Abstract

Background Data on non‐motor symptoms (NMS) in black Africans with Parkinson's disease (PD) are sparse. Objective To describe the profile of NMS in the Nigeria PD Registry (NPDR) cohort and explore the relationship between NMS and PD motor phenotype. Methods We conducted a cross‐sectional study of the frequency and burden of NMS, based on the non‐motor symptoms scale (NMSS) and the Chaudhuri method respectively in our cohort. Baseline demographics, disease characteristics (Hoehn and Yahr stage, MDS‐UPDRS total score and Part III motor score), motor phenotype (based on Stebbin et al's algorithm), and levodopa equivalent daily dose (LEDD) were documented. Results Data are presented for 825 PD whose mean age at study was 63.7 ± 10.1 years, female sex—221 [26.8%] while median PD duration was 36 months. PD phenotypes included tremor‐dominant 466 (56.5%), postural instability and gait disorder (PIGD) 259 (31.4%), and indeterminate 100 (12.1%). 82.6% were on treatment (median LEDD of 500 mg/24 hours). 804 (97.5%) endorsed at least 1 NMS. The median NMSS score was 26.0 while subscores for urinary and sexual function domains were significantly higher in males (P < 0.05). PIGD‐PD had more frequent NMS and higher frequency of severe/very severe NMSS burden (P = 0.000 for both). Nocturia and fatigue were the most prevalent NMS overall and across motor subtypes. PIGD phenotype and total UPDRS scores were the independent determinants of NMSS scores (P = 0.000). Conclusion The profile and burden of NMS, and association with motor subtype in our black African cohort is largely similar to descriptions from other populations.

APOE E4 is associated with impaired self-declared cognition but not disease risk or age of onset in Nigerians with Parkinson’s disease

“…Our findings regarding the higher frequency of abnormal cognition in the PIGD phenotype corroborate the previously documented association of this motor phenotype with a higher burden of abnormal cognition, greater risk for incident dementia in PD and a faster rate of cognitive decline [31][32][33] . The motor phenotype distribution in this study is similar to that previously described in our cohort overall (TD 56.5%, PIGD 31.4% and ID 12.1%, respectively) 34 . Although we consider our findings preliminary, the trend towards the less severe tremor-dominant motor phenotype in ε2 carriers may signify a protective effect on motor severity.…”

“…In this study, cognition scores of 0 and 1 were interpreted as PD with normal cognition, whereas scores of 2–4 were regarded as abnormal cognition. Motor phenotype was determined using the method described by Stebbins et al 34 , 43 . In summary, the phenotypes are computed using specified MDS UPDRS items for computing tremor score (Part II item 2.10 and Part III items 3.15–3.18 assessing postural, kinetic and rest tremor and rest tremor constancy) and postural instability/gait difficulty (PIGD) score (Part II items 2.12 (walking and balance), 2.13 (freezing), 3.10 (gait), 3.11 (freezing of gait) and 3.12 (postural instability)).…”

The 2022 symposium on dementia and brain aging in low‐ and middle‐income countries: Highlights on research, diagnosis, care, and impact

“… 99 Collectively, these data suggest that cognitive impairment is highly prevalent in the African PD population and similar to that in other populations. 99 …”

“…99 Collectively, these data suggest that cognitive impairment is highly prevalent in the African PD population and similar to that in other populations. 99 Epidemiological data on PD-associated cognitive impairment are still lacking in LMICs. There is an especially urgent need for robust estimates of prevalence, incidence, and risk factors from populationbased studies to better evaluate the burden of PD-associated cognitive impairment in diverse populations.…”

“…Another Nigerian study assessing the frequency of cognitive impairment and depression among 40 PD patients reported that 60% of PD patients had cognitive impairment compared to 5% in controls 98 . A more recent study assessing the profile and burden of NMS within 825 members of the Nigeria Parkinson Disease Registry reported that frequencies of cognitive complaints ranged between 27% and 46% 99 . Collectively, these data suggest that cognitive impairment is highly prevalent in the African PD population and similar to that in other populations 99 …”