Abstract
Introduction Pain is a major nonmotor symptom of Parkinson's disease (PD), and central parkinsonian pain is the core feature of the putative Park pain subtype of PD. This study aimed to explore the cognitive and behavioral profile of PD patients with central parkinsonian pain. Material and Methods. A structured interview was used to identify and characterize pain in a cohort of 260 consecutive PD patients. The Ford classification of pain was applied. The Dementia Rating Scale-2 (DRS-2) and the Impulse Control Disorders in Parkinson's Disease Short Form (QUIP-S) were administered, and patients' smoking habits were recorded. The Unified Parkinson's Disease Rating Scale (UPDRS) was used to assess motor and nonmotor symptoms in off and on conditions. Results One hundred and eighty-eight patients (68%) reported pain; and in 41 (22%) of them, the pain was classified as central parkinsonian pain. PD patients with central parkinsonian pain had better cognitive performance in DRS-2 Initiation/Perseveration and Conceptualization subscales but reported more other compulsive behaviors (e.g., hobbyism, punding, and walkabout) and had more current smoking habits than those without pain or with non-central parkinsonian pain. Multiple logistic regression analyses revealed that the DRS-2 Conceptualization subscale, other compulsive behaviors, and smoking habits remained statistically associated with central parkinsonian pain even when other significant covariates were considered. Only patients with pain, regardless of type, had a gambling disorder. Discussion. The study results provide further evidence that pain revealed that patients with central parkinsonian pain are more likely to present compulsive or addictive behaviors, despite having more preserved cognitive performance. Patients with central parkinsonian pain appear to have a distinct phenotype of PD.
Highlights
Pain is a major nonmotor symptom of Parkinson’s disease (PD), and central parkinsonian pain is the core feature of the putative Park pain subtype of PD. is study aimed to explore the cognitive and behavioral profile of PD patients with central parkinsonian pain
It has been recognized that PD is highly heterogeneous, regarding clinical presentation and progression [2]. e emergence of patterns of co-occurrence or clustering of certain nonmotor symptoms has led to the proposal of nonmotor subtypes of PD [3, 4]
One patient refused to participate in the study, 53 were excluded before assessment (i.e., 13 moved geographically to a region not dependent from our center or could not be reached between inclusion and assessment, 4 could not be assessed due to logistic problems, 2 developed other debilitating conditions, 7 died, and 27 had less than three years of education) and 8 were excluded after the assessment (i.e., 3 due to inability to complete the Dementia Rating Scale-2 (DRS-2), 3 had a change in the diagnosis, and 2 due to incomplete data set)
Summary
Parkinson’s disease (PD) is a complex neurodegenerative disorder that includes motor and nonmotor symptoms, such as dementia, sleep disorders, autonomic dysfunction, sensory, and psychiatric symptoms [1]. Sauerbier et al has suggested seven specific nonmotor symptom-dominant phenotypes, including a Park pain subtype [3]. Central parkinsonian pain is believed to be the only subtype of pain that is directly related to the disease itself and is the core feature of the putative Park pain subtype [6]. Patients with central parkinsonian pain are known to be younger, have earlier disease onset, fewer comorbidities, greater nonaxial motor symptom severity in on, more painrelated disability, more sleep disturbances, and more relief of pain with antiparkinsonian medication than patients with non-central parkinsonian pain [7, 8]. It is widely recognized that younger patients with PD usually have more preserved cognition and are at a higher risk of presenting impulse control disorders [9, 10]. E general aim of this study was to carry out a cognitive and behavioral characterization of PD patients with pain, those with central parkinsonian pain
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