Study of non-motor Symptoms in Parkinsons disease and its impact on their quality of life

Abstract

Parkinson's disease (PD) is a neurodegenerative disorder characterised by the degeneration of dopaminergic nigrostriatal pathway. Its incidence ranges from 1 to 2 per 1000 in general population. Its a complex disorder characterised by motor and non-motor symptoms that can impair the quality of life (QoL). In the presence of effective symptomatic therapies for the motor symptoms of Parkinson's disease, the non-motor symptoms have become the major prognostic factors determining the overall disease burden and everyday function in Parkinson’s disease patients. Our study aimed at assessing the frequency and proportion of non-motor symptoms in PD patients and to assess their impact on QoL. A total of 88 PD patients visiting the outpatient department of Neurology at Goa Medical College were assessed for various non-motor symptoms using a semi – structured questionnaire and appropriate scales. Quality of life was assessed using PDQ-39 questionnaire. Patients satisfying the United Kingdom Parkinson’s Disease brain bank criteria for idiopathic Parkinson’s diseases were included in the study Single centre, Cross-sectional study. Mean age of study population was 68 years and mean duration of the disease was 5yrs. Attention and memory were the most frequently reported domain in the study population (52 patients, 59.75 percent) followed by mood and cognition (46 patients, 52.74 percent). The least reported symptom was perceptual problems including delusions and hallucinations (11.74%) and miscellaneous domain (10.93 percent) which included pain, olfactory dysfunction, increased perspiration and weight fluctuations. The mean UPDRS (part 3) score was found to be 33.24± 17.37 with values ranging from 3.57 (mild motor impairment) to 44.64 (severe motor impairment).The QoL assessment showed that impairment of Mobility had a major impact on QoL followed by activities of daily living and emotional well-being. Correlation between Non-motor symptoms and PDQ-39 revealed that mood, cognition and perceptual problems had an adverse outcome on their emotional well-being and deficit in attention and memory had significant outcomes on communication. This study highlights the fact that non-motor symptoms in PD significantly impair quality of life and we should incorporate screening tools to evaluate patients with autonomic, sensory or mood disturbances so that they are detected at the earliest as most of them precede motor symptoms by decades.