Objective: To further understand non-motor fluctuations (NMF) and their relationship to other symptoms of Parkinson’s disease (PD) in a deep brain stimulation (DBS) population.

Background: Non-motor symptoms (NMS) in PD are prevalent, affect a wide range of autonomic, mood, and cognitive symptoms, and are associated with worse quality of life (1). Similar to individuals with motor fluctuations, some have NMS only during the OFF state. The clinical characteristics of those with NMF remain under-explored and there are few tools designed specifically to examine NMF.  Previous work suggested the validity of using a visual analogue scale (VAS, 2). We developed our own VAS to examine NMS during the OFF and ON medication states as an initial step towards understanding NMF in DBS candidates.

Methods: As part of an evaluation for DBS, individuals with PD were given the FLU-VAS, a questionnaire involving 10 common non-motor symptoms rated on a scale from 0 (minimal)-100 (severe). Questions were completed during the OFF state and later during the ON state, and scores for 10 questions were added together to provide the total. Additionally, motor severity in the ON and OFF states was obtained (UPDRS), and all patients underwent neuropsychiatric evaluation.

Results: In this ongoing study, 52 subjects thus far have completed the FLU-VAS in both the OFF and ON state. Subjects were 64.8 years old with 9.6 years of disease duration on average (sd = 9.3 and 4.2, respectively). NMS-OFF were more severe in women than men (p = 0.041), younger vs. older age (p = 0.032), and those with increased motor severity (p = 0.036). NMF did not show a relationship with gender, age, or UPDRS-III. Postural-instability and gait-disorder (PIGD) phenotype was associated with more severe NMS-OFF and greater NMF vs. tremor-dominant (TD) phenotype (p = 0.011 and 0.033). Global cognition (MoCA) and depression (BDI-II) scores did not correlate with NMS or NMF, though anxiety (BAI) was associated with NMS severity in both ON and OFF state (r2 = 0.18 and 0.16, p = 0.011 and 0.005).

Conclusions: Non-motor response to medication is not well captured from other scales and is important to assess. Motor response does not necessarily predict non-motor response, though NMS tend to be worse in the PIGD subtype and those with anxiety. Understanding NMF in PD is an important initial step towards determining whether NMF can be expected to improve via DBS treatment.

References: 1. Barone P, Antonini A, Colosimo C, et al. The Priamo Study : A Multicenter Assessment of Nonmotor Symptoms and Their Impact on Quality of Life in Parkinson’ s Disease. Mov Disord. 2009; 24(11):1641-1649.

2. Storch A, Schneider CB, Wolz M, et al. Nonmotor fluctuations in Parkinson disease Severity and correlation with motor complications. Neurology. 2013; 80:800-809.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluating-non-motor-fluctuations-in-parkinsons-disease-using-a-visual-analogue-scale/