Association of Motor and Nonmotor Symptoms With Health-Related Quality of Life in a Large Online Cohort of People With Parkinson Disease

Abstract

Background:There is growing interest in health-related quality of life (HRQOL) as a comprehensive view of the patient’s well-being, guiding concept for the treating clinician, and therapeutic trial outcome measure for patients with PD. The key determinants of HRQOL have not been investigated in large populations of people with PD (PwPD). Our objective was to evaluate correlates of health-related quality of life (HRQOL) in a large, online cohort of PwPD.Methods:As part of an ongoing online cohort study, we performed a cross-sectional analysis at enrollment of 23,058 PwPD. We conducted univariate and stepwise multivariate linear regression analyses of HRQOL as measured by the EQ-5D-5L tool. In addition, we performed an interaction analysis to evaluate heterogeneity of the effect of motor symptoms on HRQOL and Spearman correlation analysis to evaluate the association of non-motor symptoms with HRQOL.Results:In the multivariate linear regression model, participants with moderate or severe depression, more severe motor symptoms, and a higher burden of medical comorbidities had the most substantially decreased HRQOL as measured by the EQ index (beta=-0.11, -0.18, -0.02, -0.01 respectively, p<0.001 for all). An interaction analysis showed that more severe motor symptoms had a higher impact on individuals of female sex, lower educational level, lower income, more severe depression, and more severe cognitive impairment (p<0.01 for interaction terms). Neuropsychiatric symptoms and falls had the most negative associations with HRQOL (rho=-0.31-0.37, p<0.0001).Discussion:Potentially treatable motor and non-motor symptoms, particularly neuropsychiatric symptoms, account for a large amount of the variation in HRQOL in PwPD. Motor symptoms may have differential effects on HRQOL in different demographic and clinical subpopulations, highlighting important areas for future health disparities research. Our findings provide targets for clinician intervention and future research on symptom management to optimize HRQOL in PD.Classification of Evidence:This study provides Class II evidence that motor and neuropsychiatric symptoms are associated with HRQOL in PwPD.

Correlation of biomarker cortisol with fatigue and quality of life among men and women with idiopathic Parkinson’s disease

“…Studies have shown that women having more fatigue levels are prone to poorer quality of life and depression (18), this supports our study where women scored more on the salivary cortisol levels. Salivary cortisol has been correlated with stress, risky behavior responses, depression few studies have shown a strong positive correlation (19).…”

T‐type calcium channels as therapeutic targets in essential tremor and Parkinson's disease

“…PD is clinically manifested by cardinal symptoms of bradykinesia (slowness of movement), rigidity, or stiffness that impedes normal motor activities, and/or rest tremor 180 . The motor symptoms of PD are frequently disabled and significantly affect daily function 181 . Although the primary pathologic mechanisms driving the neurodegenerative processes in PD have not yet been fully identified, the hypokinetic symptoms, bradykinesia, and rigidity have been linked to the loss of dopamine (DA) neurons within the substantia nigra pars compacta (SNc) and the resulting reduction of striatal DA tone 182–184 .…”

“… 180 The motor symptoms of PD are frequently disabled and significantly affect daily function. 181 Although the primary pathologic mechanisms driving the neurodegenerative processes in PD have not yet been fully identified, the hypokinetic symptoms, bradykinesia, and rigidity have been linked to the loss of dopamine (DA) neurons within the substantia nigra pars compacta (SNc) and the resulting reduction of striatal DA tone. 182 , 183 , 184 Importantly, DA is a major regulator of the BG motor circuit (Figure 5 ), and degeneration of the SNc is correlated with changes in neuronal activity in BG circuits.…”

Impact of Gastrointestinal Symptoms on Health-Related Quality of Life in an Australian Parkinson’s Disease Cohort

“…Tese NMS include but are not limited to cognitive decline, mood and sleep disturbances, an impaired sense of smell, and a wide range of gastrointestinal symptoms [3,4]. In fact, research indicates that the NMS of PD may have a greater impact on health-related quality of life than the cardinal motor symptoms [5,6]. As PD does not have a cure or treatment to slow disease progression, research needs to focus on identifying factors that can be treated to improve patient quality of life.…”

“…In complex, progressive disorders, like Parkinson's disease, with a wide range of motor and nonmotor symptoms, QoL is an important factor to consider when managing the disease as each individual will be unique, in terms of the combination of symptoms at any particular time-point in the course of the disease. Although constipation can afect QoL in PwP [6,8,9], gastrointestinal symptoms remain as the top underreported [10,11], and thus, untreated symptoms in PD [5], leading to suboptimal clinical care and poorer QoL [12]. Whereas the adverse efects of other NMS such as cognitive impairment [13,14] and sleep disturbances [15,16], on QoL in PD are well-documented, the impact of gastrointestinal symptoms on QoL in PD populations has received relatively little attention in the literature.…”