Chaudhuri_EU Neurology 08/03/2010 16:12 Page 29
Neurodegenerative Disease Parkinson’s Disease
The Effect of Non-motor Symptoms on Quality of Life in Parkinson’s Disease
Claire Hinnell
1
and K Ray Chaudhuri
1,2
1. Department of Neurology, King’s College Hospital; 2. University Hospital Lewisham,
Institute of Psychiatry, London, and National Parkinson Foundation Centre of Excellence, King’s College Hospital
Abstract
Non-motor symptoms (NMS) are common in Parkinson’s disease (PD), affecting up to 90% of patients during their illness, and include
neuropsychiatric complications, autonomic disorders, sleep disturbances and sensory symptoms. Although NMS correlate strongly with
advancing disease, they may precede the onset of motor symptoms by a number of years. It is increasingly recognised that NMS result in a
significant burden for people with PD and affect quality of life (QoL) to a greater extent than motor features. However, NMS often remain
undiagnosed and untreated. Herein we review the impact of common NMS on QoL for patients with PD.
Keywords
Non-motor symptoms, Parkinson’s disease, quality of life, depression, anxiety, psychosis, cognitive impairment, sleep disorder, fatigue,
autonomic dysfunction, sensory symptoms
Disclosure: Claire Hinnell receives salary support from an unrestricted educational grant from Solvay Pharmaceuticals to King’s College Hospital and has no conflicts of interest
to declare. K Ray Chaudhuri is a consultant and member of the advisory board and speaker’s bureau for GSK, Boehringer, Teva, Solvay, Britannia, UCB and Ipsen, and has
received honoraria for international lectures from the same companies.
Received: 12 December 2009 Accepted: 22 January 2010
Correspondence: K Ray Chaudhuri, 9th Floor Ruskin Wing, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK. E:
chaudhuriray@hotmail.com
Parkinson’s disease (PD) affects about 1–2% of the population over than three.
5
In a more recent study of 49 patients with PD, McKinlay et
65 years of age and up to 3–5% of people 85 years of age and older.
1
al. found that 77% reached the cut-off for one or more NMS, while 46%
As the average age of the population increases, the prevalence of had three or more.
10
The PRIAMO study of 1,072 consecutive patients
PD can be expected to rise. There is increasing awareness that the with PD found that 98.6% of patients reported at least one NMS.
6
The
non-motor symptoms (NMS) of PD significantly contribute to the frequency of NMS increased with disease severity, and patients with
overall burden of the disease, which determines quality of life (QoL). cognitive impairment had more NMS than those without. In the latest
With this in mind, it is essential to optimise the management of all validation study of the Non-Motor Symptoms Scale (NMSS) in PD, only
aspects of PD. NMS (see Table 1) include neuropsychiatric two of 411 patients reported no NMS.
17
The same study suggested that
complications, autonomic disorders, sleep disturbances and sensory there is a close and robust correlation between the overall burden of
symptoms. NMS affect the majority of patients during their illness NMS, measured by the NMSS composite score, and QoL, measured by
and, although NMS correlate strongly with advancing disease, they the Parkinson’s Disease Questionnaire (PDQ-39). The correlation value
may precede the onset of motor symptoms by a number of years.
2–5
(Spearman r=0.7) was stronger than the correlation between QoL and
It is increasingly recognised that NMS create a significant burden for motor state. This study is one of the first to establish the close link
people with PD and affect QoL to a greater extent than motor between NMS and QoL in a statistical manner in an international study
features.
6–14
Without careful attention, NMS may remain undiagnosed spanning PD patients across all disease stages.
17
Our review focuses
and untreated. A recent international survey showed that up to 62% on the impact of common NMS on QoL for patients with PD.
of NMS in PD might remain undeclared to healthcare professionals
because patients are either embarrassed or unaware that their Neuropsychiatry
symptoms are linked to PD.
15
Using a screening tool can help to Neuropsychiatric symptoms are among the most common NMS in PD,
identify the problem. For example, in a study using the NMS constitute a major problem in management, cause reduced QoL for
Questionnaire (NMSQ), PD patients reported nine to 12 different NMS patients and increase care-giver distress.
18
in their clinic visit, many of which had not been discussed with the
doctor before being flagged by the NMSQ.
16
Depression and Anxiety
Depression can occur early and may precede motor symptoms. The
Scale and Impact of the Problem of rate of depression in community-based samples of patients with PD is
Non-motor Symptoms in Parkinson’s Disease approximately 30–40%.
19
Identification of mood disturbances is critical
NMS occur in up to 90% of patients with PD during their disease as it is well known that depression is the most significant predictor of
course.
5
Shulman et al. studied 99 patients with PD without dementia QoL in patients with PD.
7,8,11,13,20,21
Anxiety is relatively under-investigated
and reported that over half had at least two NMS and 25% had more in PD, despite being present in up to 55.8% of patients.
6
© TOUCH BRIEFINGS 2009 29
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