Abstract
Background Frequently used nonmotor scales do not cover all aspects of dysautonomia in Parkinson's disease (PD). This study explores the association between autonomic symptoms and sicca symptoms with other nonmotor symptoms and health-related quality of life (QoL) in PD. Methods Autonomic symptoms (Survey of Autonomic Symptoms, SASs), motor function (Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale III, MDS-UPDRS III), nonmotor symptoms (nonmotor symptoms questionnaire, NMS-Quest), and QoL (PD Questionnaire-39, PDQ-39) were analysed in 93 PD patients without dementia. Multivariable and multivariate analyses were performed to study the association between clinical parameters and PDQ-39 domains. Results Among the autonomic symptoms, sicca symptoms (xerostomia and dry eyes) were the most commonly reported (69%), followed by sexual dysfunction in men, leaking of urine, vasomotor dysfunction, constipation, sudomotor dysfunction, and orthostatic symptoms. The autonomic symptom burden (SAS total) correlated with the NMS-Quest and Hoehn and Yahr stage, but not with age, levodopa equivalent daily dose, disease duration, and the MDS-UPDRS III. The SAS total score was an independent predictor of the PDQ-39 summary index and mainly affected the PDQ-39 cognition and emotional well-being domains. Sicca symptoms were not associated with age, MDS-UPDRS III, disease duration, Hoehn and Yahr stage, and levodopa equivalent daily dose but aggravated the PDQ-39 domains: cognition, emotional well-being, bodily discomfort, and mobility. Sicca symptoms frequently occur together with other nonmotor symptoms, namely, urine urgency, orthostatic problems, and concentration problems. Overall, 75% of the subjects took at least one drug that can cause sicca symptoms (anti-PD medication, antidepressant drugs, antihypertensive drugs, antipsychotic drugs, antimuscarinic drugs, and analgesic drugs). Conclusion Sicca symptoms are common in PD and negatively influence QoL. The observed association between sicca symptoms and other nonmotor symptoms provides further preliminary evidence for the growing recognition of different nonmotor clusters in PD.
Highlights
Every patient with Parkinson’s disease (PD) suffers from nonmotor symptoms [1]
In a study with 135 PD patients, 84% of the patients complained of autonomic symptoms, according to the Scales for Outcomes in Parkinson’s disease-Autonomic Dysfunction (SCOPA-AUT) [4]. e severity of autonomic symptoms was associated with higher age, longer disease duration, greater disease severity, and higher doses of dopaminergic medication [4, 5]
All patients came as planned to the hospital and received multimodal treatment by specialised therapists and medication modifications during their stay (German Multimodale Komplexbehandlung bei Morbus Parkinson). e patients were admitted for the following reasons: an increase in fluctuations, worsening dyskinesias, an increase in off-phases, evaluation for deep brain stimulation, and worsening of gait and freezing. e following categories of patients were excluded: current smokers and those suffering from diabetes mellitus, Sjogren syndrome in the anamnesis, and chemotherapy, radiation, or malignant disorders. e Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale III (MDS-UPDRS III) [11], the revised nonmotor symptoms questionnaire (NMS-Quest), and Hoehn and Yahr staging were used to evaluate motor and nonmotor symptoms
Summary
Every patient with Parkinson’s disease (PD) suffers from nonmotor symptoms [1]. Is study explores the association between autonomic symptoms and sicca symptoms with other nonmotor symptoms and health-related quality of life (QoL) in PD. Autonomic symptoms (Survey of Autonomic Symptoms, SASs), motor function (Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale III, MDS-UPDRS III), nonmotor symptoms (nonmotor symptoms questionnaire, NMS-Quest), and QoL (PD Questionnaire-39, PDQ-39) were analysed in 93 PD patients without dementia. E autonomic symptom burden (SAS total) correlated with the NMS-Quest and Hoehn and Yahr stage, but not with age, levodopa equivalent daily dose, disease duration, and the MDS-UPDRS III. Sicca symptoms were not associated with age, MDS-UPDRS III, disease duration, Hoehn and Yahr stage, and levodopa equivalent daily dose but aggravated the PDQ-39 domains: cognition, emotional well-being, bodily discomfort, and mobility. Sicca symptoms are common in PD and negatively influence QoL. e observed association between sicca symptoms and other nonmotor symptoms provides further preliminary evidence for the growing recognition of different nonmotor clusters in PD
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