The severity progression of non-motor symptoms in Parkinson\u2019s disease: a 6-year longitudinal study in Taiwanese patients

Yi-Chieh Chen,Chiung Chu Chen,Ying-Zu Huang,Yi-Hsin Weng,Rou-Shayn Chen,Yi-Ying Lin,June Hung

doi:10.1038/s41598-021-94255-9

Yi-Chieh Chen, Chiung Chu Chen + Show 5 more

Open Access

https://doi.org/10.1038/s41598-021-94255-9

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Abstract

Nonmotor symptoms (NMSs) cause major burden in patients with Parkinson’s disease (PD). Previous NMSs progression studies mostly focused on the prevalence. We conducted a longitudinal study to identify the progression pattern by the severity. PD patients recruited from the outpatient clinics of a tertiary medical center were evaluated by the Unified Parkinson's Disease Rating Scale and Non-Motor Symptoms Scale (NMSS). A retrospective study with three-step analysis was performed. Step 1, the NMSs severity was compared among patients stratified by disease duration every 2 years up to 10 years. Step 2, patients with repeated tests in 2 years were categorized into 4 groups by the diseased duration of every 5 years. Step 3, the NMSS score changes in 6 years follow-up were determined, and the dosage of anti-PD drugs was compared to the NMSs severity changes. 676 patients completed the step 1 analysis, which showed a trend of NMSs worsening but not significant until the disease duration longer than 4–6 years. Furthermore, the severity did not change between repeated evaluations in 2 years in all patients. The progression became apparent after 6 years. Individual symptoms had different progression patterns and the increment of medications was independent to NMSs evolution. We demonstrated the NMSs severity progression in Taiwanese PD patients and the independence of the medications and NMSs progression.

Highlights

Nonmotor symptoms (NMSs) cause major burden in patients with Parkinson’s disease (PD)
These results indicated that Taiwanese patients with PD showed a trend of intensifying NMSs during the first 10 years of disease duration; this trend was not significant until the observation duration exceeded 4 to 6 years
To the best of our knowledge, this is the first long-term longitudinal study conducted in Asia that focuses on the progression of NMSs

Summary

Introduction

Nonmotor symptoms (NMSs) cause major burden in patients with Parkinson’s disease (PD). Numerous studies have used a specialised questionnaire called the Non-Motor Symptom Scale (NMSS)[1] to measure the prevalence and severity of N MSs2–5. The 2 groups had comparable disease burden of NMSs, but their disease duration differed by 2 years This result indirectly implies the slow evolution of NMSs. A study on progression markers in the premotor phase of PD showed that the frequency of nonmotor prodromal markers did not increase within 2 years, and that the progression of motor and nonmotor markers seemed independent[7]. A sex difference in NMSs in Taiwanese patients with PD was identified in a previous large-scale cross-sectional study, which revealed that male patients with PD had more severe NMSs11. Whether sex differences exist in the progression of NMSs, in terms of NMS severity, has not been studied for Taiwanese patients with PD

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