Objective: Analyze the association between non-motor symptoms and severity of axial symptoms in patients with Parkinson’s disease.

Background: Parkinson’s disease (PD) is characterized by the presence of motor and non-motor symptoms (NMS). It’s been observed that the postural instability with gait difficulty (PIGD) subtype course with a higher amount of NMS than other clinical motor subtypes (CMS). However, no association between the severity of axial symptoms and the amount and type of NMS have previously been described.

Method: A cross-sectional study was conducted to assess the relationship between NMS and severity of axial symptoms. A complete medical history, along with the Unified Parkinson Disease Rating Scale part III (UPDRS-III), and Non-motor Symptoms Questionnaire (NMSQ) were performed. The patients were cataloged into every CMS using the method proposed by Stebbins et al, 2013. The UPDRS-III was divided into an axial subscore using the gait/posture items to sort patients with and without PIGD. Each qualitative variable, was analyzed between CMS and patients with and without PIGD using chi-square test. Quantitative variables were performed by unpaired t-test. A Pearson correlation was done to examine the relationship between NMS and axial symptoms.

Results: A total of 73 patients were assessed, with an age of 56.6±10 years, 43(58.9%) were male and a PD duration of 7.5±5.1 years. In total, the patients had a 12±5.3 NMSQ score, being the mood, sleep and gastrointestinal symptoms the most frequent. The distribution of clinical subtypes is as followed: Akinetic-rigid 28(38.4%), Tremor dominant 9(12.3%), and PIGD 36(49.3%). When comparing the subjects with and without PIGD these differences were found: Age (53.8±10.5 vs  59.5±8.6, p=0.01), PD duration (9.6±5.6 vs 5.5±3.7, p=0.001), patients with delusions (8 vs 2, p=0.04). No differences were found in the overall NMSQ and UPDRS-III scores. No association was found between the amount of NMS and severity axial symptoms (r=0.03, p=0.8) however, a negative correlation with cardiovascular symptoms was observed (r=-0.25, p=0.03).

Conclusion: It was seen that PD duration has a higher impact on PIGD that age itself, also delusion are more prevalent in these patients. Even though a low negative correlation was seen with cardiovascular symptoms overall, the patients with a more severe PIGD, does not have an association with a higher amount of NMS.

References: Stebbins, G. T., Goetz, C. G., Burn, D. J., Jankovic, J., Khoo, T. K., & Tilley, B. C. (2013). How to identify tremor dominant and postural instability/gait difficulty groups with the movement disorder society unified Parkinson’s disease rating scale: Comparison with the unified Parkinson’s disease rating scale. Movement Disorders, 28(5), 668–670. doi:10.1002/mds.25383

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MDS Abstracts - https://www.mdsabstracts.org/abstract/association-between-non-motor-symptoms-and-severity-of-axial-symptoms-in-patients-with-parkinsons-disease/