Category: Parkinson's Disease: Non-Motor Symptoms
Objective: To evaluate the demographic and clinical correlates of Parkinson’s disease (PD) patients with fluctuations of neuropsychiatric symptoms (NPS-F).
Background: Clinical correlates of fluctuations of neuropsychiatric symptoms (NPS-F) are unknown in Parkinson’s disease (PD).
Method: We enrolled consecutive subjects with moderate PD. The Wearing-Off Questionnaire (WOQ-19), PD sleep scale 2 (PDSS-2) 39-item PD Questionnaire (PDQ-39), Hamilton depression and anxiety rating scale (HDRS and HARS) were administered.
At home assessment for 5 days by the PKG®, an accelerometry-based system for detection of motor fluctuations was employed in each subject. A score ≥ 1 in one of the items of the WOQ-19 (3,5,12,13) for neuropsychiatric symptoms defined the presence of NPS-F.
Results: Out of 93 PD patients included (32 females, age 61.9±6.9 years, disease duration 10.4±4.6 years), 63 (68%) had NPS-F. Compared to subjects without neuropsychiatric fluctuations, PD with NPS-F has the following features: more severe anxiety (HARS, p=0.001) and depression (HDRS p=0.001); poorer quality of life (PDQ-39: p=0.02), more severe sleep disturbances (PDSS-2: p=0.02). They also presented higher scores at WOQ-19 for autonomic, sensorial and motor fluctuations (p=0.01: p=0.001 p=0.02). Objective assessment of wearing off by PKG showed that PD with NPS-F had fewer motor fluctuations and off-time (BK50: p=0.034).
Conclusion: NPS-F in PD occur in the context of less severe motor fluctuations and off-time as per objective assessment via a wearable sensor. Yet, they are associated with high burden of anxiety and depression and with fluctuations in the autonomic and sensory domain.
References:  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.
 Martinez-Martin P, Schapira AH, Stocchi F, et al. Prevalence of nonmotor symptoms in Parkinson’s disease in an international setting; study using nonmotor symptoms questionnaire in 545 patients. Mov Disord. 2007;22(11):1623-1629.
 Gallagher DA, Lees AJ, Schrag A. What are the most important nonmotor symptoms in patients with Parkinson’s disease and are we missing them? Mov Disord. 2010;25(15):2493-2500.
Lang AE, Obeso JA. Challenges in Parkinson’s disease: restoration of the nigrostriatal dopamine system is not enough. Lancet Neurol. 2004;3(5):309-316.
Schrag A, Sauerbier A, Chaudhuri KR. New clinical trials for nonmotor manifestations of Parkinson’s disease. Mov Disord. 2015;30(11):1490-1504.
 Witjas T, Kaphan E, Azulay JP, et al. Nonmotor fluctuations in Parkinson’s disease: frequent and disabling. Neurology. 2002;59(3):408-413.
 Storch A, Schneider CB, Wolz M, et al. Nonmotor fluctuations in Parkinson disease: severity and correlation with motor complications. Neurology. 2013;80(9):800-809..
 Horne MK, McGregor S, Bergquist F. An objective fluctuation score for Parkinson’s disease. PLoS One. 2015;10(4):e0124522.
 Antonini A1, Martinez-Martin P, Chaudhuri RK, Merello M, Hauser R, Katzenschlager R, Odin P, Stacy M, Stocchi F, Poewe W, Rascol O, Sampaio C, Schrag A, Stebbins GT, Goetz CG. Wearing-off scales in Parkinson’s disease: critique and recommendations.Mov Disord. 2011 Oct;26(12):2169-75. doi: 10.1002/mds.23875. Epub 2011 Jul 20.
 Espay AJ, Bonato P, Nahab FB, et al. Technology in Parkinson’s disease: Challenges and opportunities. Mov Disord. 2016;31(9):1272-1282.
 Griffiths RI, Kotschet K, Arfon S, Xu ZM, Johnson W, Drago J, et al. Automated assessment of bradykinesia and dyskinesia in Parkinson’s disease. Journal of Parkinson’s disease. 2012;2(1):47-55.
 Ossig C, Gandor F, Fauser M, et al. Correlation of Quantitative Motor State Assessment Using a Kinetograph and Patient Diaries in Advanced PD: Data from an Observational Study. PLoS One. 2016;11(8):e0161559.
 Postuma RB, Berg D, Stern M, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord 2015;30: 1591–1601
 Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE. Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 2010;25:2649–2653.
 Martinez-Martin P, Rodriguez-Blazquez C, Alvarez-Sanchez M, Arakaki T, Bergareche-Yarza A, Chade A et al. Expanded and independent validation of the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). J Neurol. 2013 Jan;260(1):228-36. https://doi.org/10.1007/s00415-012-6624-1
 Ricciardi L. et al. Hypomimia in Parkinson’s disease: an axial sign responsive to levodopa. European Journal of Neurology 2020, 27: 2422–2429 doi:10.1111/ene.14452
 Schrag A, Barone P, Brown RG, et al. Depression rating scales in Parkinson’s disease: critique and recommendations. Mov Disord 2007; 22: 1077–1092.
 Leentjens AF, Dujardin K, Marsh L, et al. Anxiety rating scales in Parkinson’s disease: critique and recommendations. Mov Disord 2008; 23: 2015–2025.
 Marin RS, Biedrzycki RC, Firinciogullari S. Reliability and validity of the apathy evaluation scale. Psychiatry Res 1991; 38: 143–162.
 Crispin Jenkinson ‘, Ray Fitzpatrick, Viv Peto ‘, Richard Greenhall, Nigel Hyman.The Parkinson’s Disease Questionnaire (PDQ-39): development and validation of a Parkinson’s disease summary index score. Age and Ageing 1997; 26: 353-357
 Pablo Martinez-Martin et al. The Parkinson’s Disease Sleep Scale–2 (PDSS-2): Validation of the Spanish Version and Its Relationship with a Roommate-Based Version. MOVEMENT DISORDERS CLINICAL PRACTICE 2019; 6(4): 294–301. doi: 10.1002/mdc3.12749
 Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540–545. doi:10.1093/sleep/14.6.540
 Fanciulli et al. Validation of the Neurogenic Orthostatic Hypotension Ratio with Active Standing. Annals of Neurology. DOI: 10.1002/ana.25834
 Stocchi et al. Early DEtection of wEaring off in Parkinson disease: the DEEP study. Parkinsonism Relat Disord. 2014 Feb;20(2):204-11. doi: 10.1016/j.parkreldis.2013.10.027
 Seki M. et al. Clinical features and varieties of non-motor fluctuations in Parkinson’s disease: a Japanese multicenter study. Park Relat Disord. 2013 Jan;19(1):104-8. doi: 10.1016/j.parkreldis.2012.08.004.
 Stacy M, Hauser R. Development of a Patient Questionnaire to facilitate recognition of motor and non-motor wearing-off in Parkinson’s disease. J Neural Transm (Vienna). 2007 Feb;114(2):211- 7. https://doi.org/10.1007/s00702-006-0554-y
 Riley DE, Lang AE. The spectrum of levodopa-related fluctuations in Parkinson’s disease. Neurology 1993 Aug;43(8):1459e64
 Kotschet K, Johnson W, McGregor S, Kettlewell J, Kyoong A, O’Driscoll DM, et al. Daytime sleep in Parkinson’s disease measured by episodes of immobility. Parkinsonism Relat Disord. 2014;20(6):578-83.
 Farzanehfar P. Sensor Measurements Can Characterize Fluctuations and Wearing Off in Parkinson’s Disease and Guide Therapy to Improve Motor, Non-motor and Quality of Life Scores. Front. Aging Neurosci, 2022. Vol. 14 – 2022 | doi:10.3389/fnagi.2022.852992
 Woodrow et al. A blinded, controlled trial of objective measurement in Parkinson’s disease. NPJ Parkinsons Dis. 2020 Nov 20;6(1):35. doi: 10.1038/s41531-020-00136-9.
 Pontone G.M. et al. Anxious fluctuators’ a subgroup of Parkinson’s disease with high anxiety and problematic on-off fluctuations. Parkinsonism and Related Disorders 105 (2022) 62–68
 N. Holford, J.G. Nutt, Disease progression, drug action and Parkinson’s disease: why time cannot be ignored, Eur. J. Clin. Pharmacol. 64 (2) (2008 February 01) 207–216.
 J.G. Nutt, W.R. Woodward, J.P. Hammerstad, J.H. Carter, J.L. Anderson, The “onoff” phenomenon in Parkinson’s disease. Relation to levodopa absorption and transport, N. Engl. J. Med. 310 (8) (1984 February 23).
 Del Prete E. et al. Do neuropsychiatric fuctuations temporally match motor fuctuations in Parkinson’s disease? Neurological Sciences (2022) 43:3641–3647
To cite this abstract in AMA style:A. Trinchillo, FP. Cucinotta, A. de Angelis, I. Cociasu, M. Horne, F. Morgante, L. Ricciardi. Defining neuropsychiatric symptoms fluctuations in Parkinson’s disease [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/defining-neuropsychiatric-symptoms-fluctuations-in-parkinsons-disease/. Accessed September 22, 2023.
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