Chaudhuri_EU Neurology 08/03/2010 16:13 Page 32
Neurodegenerative Disease Parkinson’s Disease
In a study assessing chronic pain in PD, Negre-Pages et al. found the proportion than in the controls. Although sweating disturbances
prevalence to be 62%.
55
The same study found that patients with PD- were related to other symptoms of autonomic dysfunction, there
related pain had worse QoL (PDQ-39) than PD patients with non- was no association with overall QoL (PDQ-39 and EuroQ-5D). The
PD-related pain and PD patients with no pain.
55
Patients with PD have responses to the questionnaire highlighted the impact of sweating
less frequent analgesic consumption than non-PD patients, which on daily life: patients with sweating frequently felt cold/
may reflect under-reporting or under-treatment.
55
uncomfortable (33%), had disturbed sleep (29%), had to change
nightwear (8%), were limited in social activities (4%), felt
Olfactory Disturbance embarrassed (8%) and felt down (20%).
63
Olfactory dysfunction may affect up to 90% of PD patients and has
been shown to be a pre-clinical marker for the disease.
3,56,57
There is a Orthostatic Hypotension
paucity of research on the impact of olfactory dysfunction suffered by Half of patients with PD complain of non-specific symptoms such as
patients with PD. giddiness, transitory defective vision, nausea, cerebral hypoxaemia
and dizziness.
60
Loss of consciousness is rare but can lead to serious
Autonomic Dysfunction injury.
60
Orthostatic hypotension is the most frequent cardiovascular
Autonomic dysfunction is an important NMS of PD and includes a symptom, reported by almost half of hospital inpatients with PD.
59,60
range of problems such as urinary, cardiovascular, sexual and Blood pressure not only drops significantly upon rising, but also fails
gastrointestinal symptoms. These problems can occur early in the to normalise again over many minutes. In a study by Magerkurth et
disease course and are not necessarily related to disease duration or al. of consecutive hospitalised PD patients, orthostatic dizziness had
severity.
58,59
Autonomic symptoms occur significantly more often in more impact on the daily lives of patients with PD than on age-
patients with PD than in age-matched controls and have a major matched controls.
59
impact on the daily life of those with PD. In a study of 141 hospitalised
patients with PD, 50% rated the effect of autonomic symptoms as ‘a Dribbling of Saliva
lot’ or ‘very much’.
59
Dribbling of saliva is a frequent complaint in patients with PD,
occurring in 30–74%, and results not only from excess production of
Bladder Dysfunction saliva but also from infrequent or impaired swallowing.
40,64
Like other
Bladder dysfunction, including urgency, nocturia, frequency and NMS, drooling can pre-date the diagnosis of PD and is often under-
incontinence, is reported more commonly and has a greater impact treated.
64
In an analysis of 63 PD patients with drooling, 73% had mild
on the daily life of patients with PD than in age-matched controls.
59
to moderate drooling and 27% had severe or profuse drooling.
The impact can be severe: urogenital infections are a frequent cause Dribbling of saliva had both emotional and social consequences in up
of death in parkinsonism.
60
to 77% of patients – and to a significantly greater in patients with
more severe drooling.
64
Using a representative sample of a community-living Canadian
population, Pohar and Allyson Jones found that having urinary Dysphagia
incontinence results in an additional burden for the PD patient.
61
In a Nine out of 10 patients with PD develop dysphagia during the course
questionnaire-based assessment of pelvic dysfunction in patients with of their disease.
65
The consequences are severe as aspiration
PD, Sakakibara et al. found that patients with PD had a significantly pneumonia is the leading cause of death in this group.
66
higher frequency of urinary urgency, daytime and night-time frequency,
incontinence, hesitancy, poor stream and straining than the control There are few studies investigating the impact of dysphagia on QoL
group.
62
Patients with PD reported more dissatisfaction with bladder in patients with PD. Plowman-Prine et al. compared PD patients
dysfunction than controls. Rahman et al. found that urinary with dysphagia versus those without, using swallow-specific QoL
incontinence had an effect on QoL (PDQ-39) in patients with PD, but the (SWAL-QOL), general QoL (PDQ-39) and depression (BDI) as
result was not statistically significant; however, urinary incontinence did outcome measures. Both the dysphagic and non-dysphagic groups
emerge as a predictor of QoL.
22
had a mild to moderate reduction in SWAL-QOL, although the
dysphagic group had worse total SWAL-QOL scores. The worse
Sexual Dysfunction the SWAL-QOL score, the worse the general QoL, which is perhaps
Sexual dysfunction is common in PD but no studies have examined not surprising given the overlap of questions in the two measures.
its effect on QoL using validated measures. A decrease in libido, The dysphagic group had significantly worse social function and
sexual intercourse and orgasm, and problems with erection and mental health than the non-dysphagic group. Depression increased
ejaculation, occur significantly more frequently in patients with PD with worse SWAL-QOL. Interestingly, patient-reported SWAL-QOL
than in controls.
62
Although one might expect sexual dysfunction to was not related to disease duration or severity, suggesting that
negatively affect patients, Sakakibara et al.
62
found that the rate of dysphagia is an important issue not only in advanced disease but
dissatisfaction with sexual dysfunction was not significantly higher throughout all stages of disease.
67
for patients with PD compared with controls.
62
Using a semi-structured interview and qualitative analysis in a sample
Sweating of 37 patients with PD, Miller et al. found that dysphagia affects not
There is a paucity of work examining the impact of sweating on QoL only the lives of people with PD but also their carers, and swallowing
in PD, despite studies showing that it affects almost half of impairment need not be severe before having a significant impact.
68
patients.
59
Swinn et al. assessed 77 consecutive patients with PD The consequence of dysphagia is not limited to difficulty chewing and
using a novel questionnaire and found that almost two-thirds swallowing, but also applies to activities surrounding mealtimes such
reported a problem with sweating – a significantly higher as shopping, preparation and socialisation.
68
32 EUROPEAN NEUROLOGICAL REVIEW
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