Parkinson Disease: The Relationship Between Non-motor Symptoms and Motor Phenotype

Abstract

Background: Parkinson disease (PD) presents with motor and non-motor symptoms (NMS). The NMS often precede the onset of motor symptoms, but may progress throughout the disease course. Tremor dominant, postural instability gait difficulty (PIGD), and indeterminate phenotypes can be distinguished using Unified PD Rating scales (UPDRS-III). We hypothesized that the PIGD phenotype would be more likely to develop NMS, and that the non-dopamine-responsive axial signs would correlate with NMS severity. Methods: We conducted a retrospective cross-sectional chart review to assess the relationship between NMS and PD motor phenotypes. PD patients were administered the NMS Questionnaire, the UPDRS-III, and the Mini-Mental State Examination score. The relationship between NMS burden and PD subtypes was examined using linear regression models. The prevalence of each NMS among difference PD motor subtypes was analyzed using chi-square test. Results: PD patients with more advanced disease based on their UPDRS-III had higher NMS Questionnaire scores. The axial component of UPDRS-III correlated with higher NMS. There was no correlation between NMS and tremor scores. There was a significant correlation between PIGD score and higher NMS burden. PIGD group had higher prevalence in most NMS domains when compared with tremor dominant and indeterminate groups independent of disease duration and severity. Conclusions: NMS profile and severity vary according to motor phenotype. We conclude that in the PD population, patients with a PIGD phenotype who have more axial involvement, associated with advanced disease and poor motor response, have a higher risk for a higher NMS burden.RÉSUMÉ: La relation entre les symptômes non moteurs et le phénotype moteur de la maladie de Parkinson. Contexte: Il existe des symptômes moteurs et non moteurs dans la maladie de Parkinson (MP). Les symptômes non moteurs (SNM) précèdent souvent le début des symptômes moteurs et ils peuvent progresser pendant toute l'évolution de la maladie. On peut distinguer les phénotypes où dominent le tremblement, l'instabilité posturale et les troubles de la démarche (IPTD) et le phénotype indéterminé au moyen des Unified PD Rating Scales (UPDRS-III). Nous avons émis l'hypothèse que les SNM sont plus susceptibles de survenir chez le phénotype IPTD et que les signes axiaux qui ne répondent pas au traitement par la dopamine sont corrélés à la sévérité des SNM. Méthode: Nous avons effectué une revue transversale rétrospective de dossiers afin d'examiner la relation entre le phénotype SNM et le phénotype moteur de la MP. Des patients atteints de la MP ont été évalués au moyen du questionnaire SNM, des UPDRS-III et du mini-examen de l'état mental. Nous avons utilisé l'analyse de régression linéaire pour évaluer la relation entre le fardeau des SNM et les sous-types de MP. Nous avons analysé la prévalence de chaque SNM dans différents sous-types moteurs de MP au moyen du test du chi-carré. Résultats: Les patients atteints de la MP dont la maladie était plus avancée selon ...

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