Non motor symptoms in progressive supranuclear palsy: prevalence and severity

Fabiana Giada Radicati,Carmen Rodriguez Blazquez,Chiara Fossati,Fabrizio Stocchi,Kallol Ray Chaudhuri,Pablo Martinez Martin,Margherita Torti,Laura Vacca

doi:10.1038/s41531-017-0037-x

Fabiana Giada Radicati, Carmen Rodriguez Blazquez + Show 6 more

Open Access

https://doi.org/10.1038/s41531-017-0037-x

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Abstract

NMSs have been extensively studied in PD patients but not in other forms of parkinsonism such as Progressive Supranuclear Palsy (PSP). The primary objective of this study was to analyze the frequency, severity and the type of non-motor symptoms (NMS) in PSP patients using the non-motor symptoms scale (NMSS). The secondary objective was to differentiate NMS between PSP and Parkinson’s disease (PD). We enrolled in this cross-sectional study 50 consecutive PSP and 100 matched Parkinson’s disease (PD) patients, in the proportion PSP/PD = 1/2, matched in age, sex, and disease duration. Motor and Non Motor symptoms (different scales for each disease) were evaluated at baseline using PSP scale, SCOPA Motor, Montreal Cognitive Assessment (MOCA), HADS, Hamilton, and Non Motor Symptom scale (NMSS). Comparative analysis was done using chi-squared test, Mann-Whitney test and Fisher’s exact test. Fifty PSP (56% female) and 100 PD (59% female) patients completed the study protocol and were included for statistical analysis. The NMSS total domains score in the PSP group was 77.58 ± 42.95 (range 14–163) with NMS burden grade: 4, very severe, and the in the PD group was 41.97 ± 35.45 (range: 0–215) with NMS burden grade: 3, severe. The comparative analysis showed that NMS total score (p < 0.0001), Sleep/Fatigue (p = 0.0007), Mood/Apathy (p = 0.0001), Gastrointestinal (p < 0.0001), and Urinary dysfunction (p = 0.0001) domains were significantly more severe in PSP patients than in PD. This observational study reports that NMSs are very frequent in PSP patients hence the higher burden of NMS in PSP specifically related to mood/apathy, attention/memory, gastrointestinal, urinary disturbances compared to PD.

Highlights

Non-dopaminergic and non-motor symptoms (NMSs) are sometimes present before diagnosis of Parkinson’s disease (PD) and atypical or secondary parkinsonism (AP), and almost inevitably emerge with disease progression
NMS have been extensively studied in PD patients but not in other form of parkinsonism such as progressive supranuclear palsy (PSP)
In a Korean study on the interrelationship between NMS in atypical Parkinsonism (AP) and PD (117 PD and 57 AP, 12 of them with PSP), the results showed that the most frequent symptoms in PSP were attention/memory problems

Summary

Introduction

Non-dopaminergic and non-motor symptoms (NMSs) are sometimes present before diagnosis of Parkinson’s disease (PD) and atypical or secondary parkinsonism (AP), and almost inevitably emerge with disease progression. Non-motor symptoms often contribute to severe disability, impaired quality of life, and shortened life expectancy.[1]. NMS have been extensively studied in PD patients but not in other form of parkinsonism such as progressive supranuclear palsy (PSP). Some studies have reported the frequency of NMS in PSP. In the PRIAMO (PaRkinsondIseAse non-MOtor symptoms) study, 30 patientswith PSP were enrolled, and it was shown that the most prevalent NMS in PSP were gastrointestinal (GI) problems and fatigue. NMS prevalence was much higher in parkinsonism compared to PD, the result being aligned with the rapid and severe course of this rare disease.[2]

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