Fluctuations in nonmotor symptoms of Parkinson’s affect life quality

Problems with cognition, pain, and mental health increase over time

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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People with Parkinson’s disease tend to report a poorer quality of life if their treatments cannot fully control nonmotor symptoms, which increase with disease duration and severity, a study reported.

Findings highlight how important it is for clinicians to accurately identify and properly address nonmotor symptoms of Parkinson’s, whose fluctuations typically follow those of the disease’s motor symptoms, its researchers said.

The study, “Impact of non-motor fluctuations on QOL in patients with Parkinson’s disease,” was published in Frontiers in Neurology.

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Motor symptom fluctuations, or ‘off’ periods, are known to lower life quality

Although available Parkinson’s treatments are generally effective for managing disease symptoms, many patients experience fluctuations, or “off” times, when symptoms are not fully controlled between medication doses.

Off times are particularly common with long-term use of levodopa, a standard disease treatment.

Prior research has shown that patients with motor symptom fluctuations tend to report a poorer life quality. However, much less study has been given to how fluctuations in nonmotor symptoms, from cognitive and mental health challenges, to pain, fatigue and anxiety, affect patients’ quality of life.

Scientists at Fukuoka University in Japan conducted surveys of 375 Parkinson’s patients who were treated at their clinic between 2015 and 2018.

“To date, no studies have evaluated the relationship between non-motor fluctuations and QOL [quality of life] in comparison with motor fluctuations,” the researchers wrote.

Patients were given a standardized measure of life quality, called the Parkinson’s Disease Questionnaire-8 (PDQ-8), as well as other measures of symptom severity. To assess fluctuations, they completed the nine-item wearing-off questionnaire (WOQ-9), which includes five questions about fluctuations in motor symptoms and four questions about nonmotor symptom fluctuations.

Based on WOQ-9 data, 149 patients reported no symptom fluctuations, and another 128 experienced motor symptom fluctuations.

The remaining 98 patients — slightly more than a quarter (26.1%) of the total group — reported fluctuations in nonmotor symptoms. Most of these people also noted fluctuations in motor symptoms.

“Generally, non-motor fluctuations appear after the presence of motor fluctuations, however, in this study there were a few cases in which only non-motor fluctuations were seen,” the researchers wrote.

Symptom fluctuations were more likely in patients who had been living with Parkinson’s disease for longer periods, starting at two to four years after a disease diagnosis and highest among those diagnosed 10 or more years earlier.

In statistical analyses, average quality of life scores on the PDQ-8 were significantly poorer among patients with nonmotor fluctuations, compared with those with no fluctuations or only motor fluctuations.

Significant linear correlations were seen between PDQ-8 scores and WOQ-9 scores — in other words, patients with more symptom fluctuations were statistically more likely to report a poorer quality of life. Separate analyses for fluctuations in motor and nonmotor symptoms showed that both significantly associated with life quality.

“The non-motor fluctuations affected QOL independently of motor fluctuations,” the researchers wrote, adding that this highlights the importance of accurately evaluating and addressing nonmotor fluctuations.

Researchers emphasized that this study is limited by its single-center nature. They also noted that, while the simplicity of the WOQ-9 makes it easy to use in clinical practice, by nature it doesn’t provide much detail on symptom fluctuations, and further research is needed to validate and expand on these findings.