Non-motor symptoms in essential tremor, akinetic rigid and tremor-dominant subtypes of Parkinson's disease.

Alia H Mansour,Hadeer Mohamed,Osama Ali Abulseoud,Ali S Shalash,Mahmoud Elbalkimy,Eshak I Bahbah,Eman Hamid,Hanan Elrassas

doi:10.1371/journal.pone.0245918

Alia H Mansour, Hadeer Mohamed + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0245918

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Journal: PloS one	Publication Date: Jan 27, 2021
Citations: 10	License type: CC BY 4.0

Affiliation: Ain Shams University, Al Azhar University

Abstract

ObjectivesTo compare non-motor symptoms (NMSs) among patients with essential tremor (ET), Parkinson’s disease (PD) subtypes (akinetic-rigid type (ART) and tremor-dominant type (TDT)), and healthy controls.Patients and methodsThis retrospective study included 129 participants, 72 PD (33 PD-ART, 33 PD-TDT, and 6 Mixed), 29 ET patients, and 28 controls. PD patients were assessed by the unified Parkinson’s disease rating scale (UPDRS), Hoehn, and Yahr scale (H&Y), while ET patients were evaluated by the Fahn Tolosa Marin Tremor Rating Scale. All subjects were evaluated by non-motor symptoms scale (NMSS) for NMSs and Beck depression inventory (BDI) for depression.ResultsPD subtypes groups, ET, and controls were age and gender-matched. Compared to controls, all PD, PD subtypes, and ET showed significantly worse most of NMSs (p<0.001) and depression. Compared to ET, all PD and PD-ART had significantly worse gastrointestinal (p = 0.002), urinary symptoms (p = 0.001, p = 0.003) and depression (p = 0.002) and PD-TDT worse depression, while ET patients showed worse memory/attention than PD subtypes. Total NMSS of ET is highly correlated to depression and moderately to tremor severity and age of onset, while total of NMSS is highly correlated to depression, disease severity, and disability.ConclusionThe current study demonstrated several comparable domains of NMSs of PD subtypes and ET, except worse gastrointestinal and urinary symptoms among PD-ART. Identifying different NMSs profiles is important for predicting, better assessing, and tailoring management of ET and PD subtypes.

Highlights

Essential tremor (ET) and Parkinson’s disease (PD) are common tremor disorders in adults with increased prevalence with age
Total non-motor symptoms scale (NMSS) of ET is highly correlated to depression and moderately to tremor severity and age of onset, while total of NMSS is highly correlated to depression, disease severity, and disability
The current study demonstrated several comparable domains of nonmotor symptoms (NMSs) of PD subtypes and ET, except worse gastrointestinal and urinary symptoms among PD-akinetic-rigid type (ART)

Summary

Introduction

Essential tremor (ET) and Parkinson’s disease (PD) are common tremor disorders in adults with increased prevalence with age. ET and PD affect about 4.6% [1] and 1% of populations older than 65 years [2] respectively and share overlapping clinical motor features, resulting in occasional difficulty to differentiate between them [3]. Both diseases were described mainly as motor disorders with different phenotypes, followed by recognition of associated nonmotor symptoms (NMSs). The postural and kinetic tremors of the upper limbs are the main symptoms of ET. Other motor symptoms were reported, including gait ataxia, postural instability, disturbances of the eye movement, resting tremor, rigidity, and mild bradykinesia. Several NMSs are progressively being recognized with ET, including cognitive decline, depression, anxiety, pain, hearing impairment, and sleep problems [5,6]

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