Objective: To determine whether non-motor symptoms predict the development of functional dependency in Parkinson’s disease (PD).

Background: Non-motor symptoms are increasingly recognized as an integral component of PD. Growing evidence has shown that earlier development of non-motor symptoms is associated with a more rapid disease progression of PD, which suggests that such symptoms may be one of the most useful markers for predicting functional dependency. However, the impact of non-motor symptoms on the development of dependency has been unclear.

Method: This study using the PPMI data included 405 patients with newly diagnosed PD without functional dependency at baseline visit. We collected baseline demographic and clinical data. Non-motor symptoms were measured using well-validated instruments covering neuropsychiatric, sleep-related, olfactory, and autonomic symptoms. The development of dependency was defined to be present if a Schwab and England score of less than 80% at any time point remained during the rest of the follow-up. Cox proportional-hazards regression analyses were performed to identify predictors of dependency.

Results: During a median follow-up of 5.0 years, 61 patients (15%) became functionally dependent. Among the non-motor variables, only the REM sleep behavior disorder (RBD) screening questionnaire (RBDSQ) score was associated with the development of dependency (hazard ratio [HR] 1.20; 95% confidence interval [CI] 1.10–1.30; p=0.016). Furthermore, the bradykinesia subscore was also a significant predictor of dependency (HR 1.05; 95% CI 1.00–1.09; p=0.043). The RBDSQ score was further inserted as a dichotomous variable in the multivariable Cox model. When using a cut-off score of 5, the presence of RBD was predictive of dependency (HR 2.16; 95% CI 1.24–3.75; p=0.006). This significant association also persisted when using a cut-off score of 6 (HR 1.79; 95% CI 1.02–3.13; p=0.043).

Conclusion: The presence of RBD in patients with early PD was associated with an increased risk of functional dependency. This finding supports the notion that RBD portends poor prognosis in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-symptoms-and-risk-of-functional-dependency-in-early-parkinsons-disease/