Characterization of Non‐Motor Fluctuations Using the Movement Disorder Society <scp>Non‐Motor</scp> Rating Scale

Wamelen, Daniel J. van; Rota, Silvia; Schrag, Anette; Rizos, Alexandra; Martinez‐Martín, Pablo; Weintraub, Daniel

doi:10.1002/mdc3.13520

Cited by 9 publications

(4 citation statements)

References 26 publications

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“…Prevalence of non-motor fluctuations were found in 26.1% of the participants, and increased with severity of PD. These results were slightly lower overall than the frequency of NMF in the MDS-NMS study of 9.1% for <2 years of disease duration, 54.3% for 2–5 years, 63.6% for 5–10 years, and 71.0% for ≥10 years, with an average of 49.2% ( 22 ). It is known that factors such as older age, disease duration, reduced activity of daily living, severity of motor symptoms, and long off-time reduce the QOL score of PwPD ( 23 ).…”

Section: Discussionmentioning

confidence: 62%

Impact of non-motor fluctuations on QOL in patients with Parkinson’s disease

et al. 2023

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IntroductionLong-term levodopa treatment in patients with Parkinson’s disease (PwPD) often causes motor fluctuations, which are known to affect their quality of life (QOL). These motor fluctuations may be accompanied by fluctuations in non-motor symptoms. There is no consensus on how non-motor fluctuations affect QOL.MethodsThis was a single-center, retrospective study and included 375 patients with Parkinson’s disease (PwPD) who visited the neurology outpatient department of Fukuoka University Hospital between July 2015 and June 2018. All patients were evaluated for age, sex, disease duration, body weight, and motor symptoms by the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale part III, depression scale by the Zung self-rating depression scale, apathy scale, and cognitive function by the Japanese version of The Montreal Cognitive Assessment. A nine-item wearing-off questionnaire (WOQ-9) was used to assess the motor and non-motor fluctuations. QOL in PwPD was investigated using the eight-item Parkinson’s Disease Questionnaire (PDQ-8).ResultsIn total, 375 PwPD were enrolled and classified into three groups according to the presence or absence of motor and non-motor fluctuations. The first group included 98 (26.1%) patients with non-motor fluctuations (NFL group), the second group included 128 (34.1%) patients who presented with only motor fluctuations (MFL group), and the third group included 149 (39.7%) patients without fluctuations in motor or non-motor symptoms (NoFL group). Among them, the PDQ-8 SUM and SI were significantly higher in the NFL group than in the other groups (p < 0.005), implying that the NFL group had the poorest QOL among groups. Next, multivariable analysis showed that even one non-motor fluctuation was an independent factor that worsened QOL (p < 0.001).ConclusionThis study showed that PwPD with non-motor fluctuation had a lower QOL than those with no or only motor fluctuation. Moreover, the data showed that PDQ-8 scores were significantly reduced even with only one non-motor fluctuation.

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Section: Discussionmentioning

confidence: 62%

Impact of non-motor fluctuations on QOL in patients with Parkinson’s disease

et al. 2023

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“…According to a recent study, prevalence of NMF, evaluated by the means of the MDS-NMS rating scale (Chaudhuri et al 2020 ), was low (9.1%) in the very early stage (< 2 years), showing a rapid increase between 2 and 5 years (54%) and a substantial plateau thereafter (van Wamelen et al 2022 ). In our cohort prevalence of NMF (71.9%) was high and quite stable across the disease duration.…”

Section: Discussionmentioning

confidence: 99%

Gender differences in non-motor fluctuations in Parkinson’s disease

Donzuso,

Cicero,

Vinciguerra

et al. 2023

J Neural Transm

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Non-motor symptoms (NMS) and Non-motor fluctuations (NMF) in Parkinson’s Disease (PD) are common, involving several domains and affecting quality of life. Aim of the study is to estimate the burden of NMF in PD patients and to evaluate the possible gender effect. PD patients fulfilling the MDS-PD diagnostic criteria attending the “Parkinson’s Disease and Movement Disorders Centre” of the University of Catania were evaluated using the Non-Motor Fluctuations Assessment (NoMoFA) Questionnaire. NoMoFA items were also grouped into the following domains: cognitive, mood, sleep/fatigue, dysautonomia, hallucination/perception and miscellaneous domains were identified. One-hundred and twenty-one patients with PD (67 men, 55.4%; mean age 70.2 ± 8.9 years, disease duration 8.3 ± 4.6 years) were evaluated. All PD patients reported at least one NMS, whereas 87 (71.9%) also reported NMF. “Feel sluggish or had low energy levels” (47.2%) along with “Feel excessively sleepy during the day” (40.0%) were the most common NMF reported in the whole sample. The majority of PD patients reported the presence of NMF during the OFF state (79, 65.3%). At multivariate analysis, NMF were positively associated with the female gender (adjusted OR 3.13; 95%CI 1.21–8.11 p-value 0.01). Women with PD had higher NMF scores especially in depression/anxiety, sleep/fatigue and dysautonomia domains. Our study reported the presence of a gender-related pattern in the frequency of NMS and NMF in PD patients, with female gender associated with a higher risk of developing NMF, highlighting the need for personalized treatment strategies when addressing NMF.

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“…Recent studies have identified that up to 23.1% of patients with PD experience cognitive NMF (assessed using the MDS Non-Motor Rating Scale) [ 30 ]. Its prevalence increases as the disease progresses, with the highest prevalence in patients with a disease duration > 10 years [ 32 ]. Occasionally, individuals may experience ‘on’ period bradyphrenia and difficulties in memory retrieval, which could also be attributed to the cognitive side effects of L-dopa, as discussed below [ 33 ].…”

Section: Cognitive Disorders In Pdmentioning

confidence: 99%

“…Cognitive NMF can manifest with an acute onset inattention and fluctuating arousal, typically occurring when the effect of L-dopa disappears. Fluctuations tend to increase over the course of the disease, implying that patients with a higher NMF burden will probably have more severe PD-CI and more predisposing factors for delirium [ 32 ]. Additionally, severe motor “off” states or NMS such as unnoticed orthostatic hypotension may also mimic symptoms of delirium.…”

Section: Diagnostic and Therapeutic Challenges And Caveatsmentioning

confidence: 99%

Cognitive disorders in advanced Parkinson’s disease: challenges in the diagnosis of delirium

Daniels,

Rodríguez-Antigüedad,

Jentschke

et al. 2024

Neurol. Res. Pract.

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Parkinson’s disease (PD) is a neurodegenerative condition that is frequently associated with cognitive disorders. These can arise directly from the primary disease, or be triggered by external factors in susceptible individuals due to PD or other predisposing factors. The cognitive disorders encompass PD-associated cognitive impairment (PD-CI), delirium, PD treatment-associated cognitive side effects, cognitive non-motor fluctuations, and PD-associated psychosis. Accurate diagnosis of delirium is crucial because it often stems from an underlying disease that may be severe and require specific treatment. However, overlapping molecular mechanisms are thought to be involved in both delirium and PD, leading to similar clinical symptoms. Additionally, there is a bidirectional interaction between delirium and PD-CI, resulting in frequent concurrent processes that further complicate diagnosis. No reliable biomarker is currently available for delirium, and the diagnosis is primarily based on clinical criteria. However, the screening tools validated for diagnosing delirium in the general population have not been specifically validated for PD. Our review addresses the current challenges in the diagnosis of these cognitive disorders and highlights existing gaps within this field.

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Characterization of Non‐Motor Fluctuations Using the Movement Disorder Society Non‐Motor Rating Scale

Cited by 9 publications

References 26 publications

Impact of non-motor fluctuations on QOL in patients with Parkinson’s disease

Impact of non-motor fluctuations on QOL in patients with Parkinson’s disease

Gender differences in non-motor fluctuations in Parkinson’s disease

Cognitive disorders in advanced Parkinson’s disease: challenges in the diagnosis of delirium

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