Objective: To address the co-occurrence of the burden of non-motor symptoms staging (NMSB) and motor severity of Parkinson’s disease (PD) using the Hoehn and Yahr (HY) staging in a multi-centre study currently with 249 patients.

Background: The concept of non-motor subtypes (with increased burden of specific NMS) in PD is now recognised (Sauerbier et al 2016; Marras and Chaudhuri 2016). The relationship of NMS subtypes, NMS burden and motor staging of PD is not known.

Methods: Analysis of a global real life PD database (part of the IPMDS Non-Motor PD Study Group initiative) of 249 cases with published NMS burden grading, HY staging and additional comorbidity measures. 3 groups were analysed and identified; NMSB mild with mild HY stage (HY stages 1-2), NMSB severe with mild HY and NMSB very severe with mild HY. For analysis, Kruskal-Wallis (K-W) test was used and when the result of the K-W test was significant (p<0.05), comparisons between the groups were explored by means of the Mann-Whitney test.

Results: Those with severe and very severe NMSB but mild motor disease (mild HY) were significantly younger and had significantly higher motor disability, sleep, anxiety, depression and worse quality of life compared to those with mild NMSB and mild HY stage.

Conclusions: This ongoing study provides evidence of considerable phenotypic heterogeneity within the Parkinson’s disease spectrum supporting the concept of specific non-motor subtypes. Even though there may be mild motor disease, patients may have a very severe burden of non-motor disease dominated by sleep problems, anxiety and depression with consequent poor quality of life. These cases represent a separate phenotypic variant of PD and highlight the need for obligatory non-motor assessment of PD in the clinic.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-symptoms-burden-and-motor-staging-of-parkinsons-disease-evidence-for-dichotomy-and-non-motor-dominant-subtypes-from-analysis-of-249-cases/