Objective: To explore the relationship between motor complications, illness perceptions and cognitive beliefs about symptoms in people with Parkinson’s disease (PwP).

Background: Around 50% PwP experience motor fluctuations and dyskinesias[1]. These motor complications significantly affect quality of life (QoL) and are difficult to manage. While psychosocial factors like personality, coping strategies, and social support have been extensively studied in PwP, illness perceptions and cognitive beliefs about symptoms have received less attention, despite being well-researched in other chronic conditions such as chronic dizziness, fatigue, and multiple sclerosis[2-4]. Positive illness perceptions can improve outcomes, especially in PwP with poorly controlled symptoms[5], though the psychological impact of motor complications remains underexplored.

Method: PwP on stable medication for minimum 3 months were assessed using the MDS-UPDRS Part-IV scale to evaluate motor complications. Participants completed the Illness Perception Questionnaire-Revised (IPQ-R) Part-II which includes 7 sections rated on a 5-point Likert scale (1-5), with higher scores indicating worse perceptions. They also completed the Cognitive Behavioural Symptom Questionnaire (CBSQ), which includes 7 domains with higher scores indicating worse cognitive beliefs on a 5-point Likert scale (0-4). A subgroup used the Parkinson’s KinetiGraph (PKG)[6] for one week to collect data on dyskinesia score (DKS), fluctuation dyskinesia score (FDS), and %Time Immobile (PTI).

Results: Fifty-eight PwP (55% male, 45% female; age: 29-86; disease duration: 1-22 years; MDS-UPDRS Part-IV: 0-21) were enrolled. A correlation was found between MDS-UPDRS Part-IV and CBSQ domains (Catastrophising: ρ=.465, p<.001; Damage: ρ=.430, p=.002; Embarrassment Avoidance: ρ=.400, p=.004; Symptom Focusing: ρ=.574, p<.001; Avoidance Behaviour: ρ=.428, p=.002), and IPQ-R Part-II sections (Timeline Cyclical: ρ=.479, p<.001; Emotional Representation: ρ=.384, p=.005). In 48 PwP, correlations were found between DKS and CBSQ (Embarrassment Avoidance: ρ=.381, p=.016), and PTI and CBSQ (All-or-Nothing Behaviour: ρ=.391, p=.043; Avoidance Resting Behaviour: ρ=.333, p=.039).

Conclusion: Severe dyskinesia and motor fluctuations in PwP are associated with negative illness perceptions and cognitive beliefs. Future research should explore whether psychological approaches can help manage motor complications and improve QoL.

References: [1] Rosqvist K, Horne M, Hagell P, et al. Levodopa Effect and Motor Function in Late Stage Parkinson’s Disease. J Parkinsons Dis. 2018;8(1):59-70. doi: 10.3233/jpd-171181. PubMed PMID: 29480220; eng.
[2] Loades ME, Vitoratou S, Rimes KA, Ali S, Chalder T. Psychometric properties of the Cognitive and Behavioural Responses Questionnaire (CBRQ) in adolescents with chronic fatigue syndrome. Behav Cogn Psychother. 2020;48(2):160-171. doi:10.1017/S1352465819000390.
[3] Herdman D, Norton S, Murdin L, Frost K, Pavlou M, Moss-Morris R. The INVEST trial: a randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with Persistent Postural Perceptual Dizziness. J Neurol. 2022;269(9):4753-4763. doi:10.1007/s00415-022-11107-w.
[4] Moss-Morris R, Weinman J, Petrie K, et al. The Revised Illness Perception Questionnaire (IPQ-R). Psychol Health. 2002;17(1):1-16.
[5] Hurt CS, Burn DJ, Hindle J, Samuel M, Wilson K, Brown RG. Thinking positively about chronic illness: An exploration of optimism, illness perceptions and well-being in patients with Parkinson’s disease. Br J Health Psychol. 2014;19(2):363-379. doi:10.1111/bjhp.12043.
[6] Griffiths RI, Kotschet K, Arfon S, et al. Automated assessment of bradykinesia and dyskinesia in Parkinson’s disease. J Parkinsons Dis. 2012;2(1):47-55. doi:10.3233/JPD-2012-11071

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-feedback-loop-illness-perceptions-and-motor-complications-in-parkinsons/