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Abstract
Growing evidence suggests that non-motor symptoms (NMS) in Parkinson’s disease (PD) have differential progression patterns that have a different natural history from motor progression and may be geographically influenced. We conducted a cross-sectional analysis of 1607 PD patients of whom 1327 were from Europe, 208 from the Americas, and 72 from Asia. The primary objective was to assess baseline non-motor burden, defined by Non-Motor Symptoms Scale (NMSS) total scores. Other aims included identifying the factors predicting quality of life, differences in non-motor burden between drug-naïve and non-drug-naïve treated patients, and non-motor phenotypes across different geographical locations. Mean age was 65.9 ± 10.8 years, mean disease duration 6.3 ± 5.6 years, median Hoehn and Yahr stage was 2 (2–3), and 64.2% were male. In this cohort, mean NMSS scores were 46.7 ± 37.2. Differences in non-motor burden and patterns differed significantly between drug-naïve participants, those with a disease duration of less than five years, and those with a duration of five years or over (p ≤ 0.018). Significant differences were observed in geographical distribution (NMSS Europe: 46.4 ± 36.3; Americas: 55.3 ± 42.8; Asia: 26.6 ± 25.1; p < 0.001), with differences in sleep/fatigue, urinary, sexual, and miscellaneous domains (p ≤ 0.020). The best predictor of quality of life was the mood/apathy domain (β = 0.308, p < 0.001). This global study reveals that while non-motor symptoms are globally present with severe NMS burden impacting quality of life in PD, there appear to be differences depending on disease duration and geographical distribution.
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Details
1 King’s College London, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, London, UK (GRID:grid.13097.3c) (ISNI:0000 0001 2322 6764); Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK (GRID:grid.46699.34) (ISNI:0000 0004 0391 9020); Radboud University Medical Centre, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382); Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, London, UK (GRID:grid.13097.3c) (ISNI:0000 0001 2322 6764)
2 King’s College London, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, London, UK (GRID:grid.13097.3c) (ISNI:0000 0001 2322 6764); University of Cologne, Department of Neurology, Faculty of Medicine University Hospital Cologne, Cologne, Germany (GRID:grid.6190.e) (ISNI:0000 0000 8580 3777)
3 King’s College London, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, London, UK (GRID:grid.13097.3c) (ISNI:0000 0001 2322 6764); Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK (GRID:grid.46699.34) (ISNI:0000 0004 0391 9020)
4 Carlos III Institute of Health, National Center of Epidemiology, Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain (GRID:grid.413448.e) (ISNI:0000 0000 9314 1427)
5 Transilvania University, Department of Neurology, Faculty of Medicine, County Emergency Clinic Hospital, Braşov, Romania (GRID:grid.5120.6) (ISNI:0000 0001 2159 8361)
6 Instituto Nacional de Neurologia y Neurocirugía, Movement Disorders Unit, Mexico, Mexico (GRID:grid.419204.a) (ISNI:0000 0000 8637 5954)
7 Fukuoka University, Department of Neurology, Faculty of Medicine, Fukuoka, Japan (GRID:grid.411497.e) (ISNI:0000 0001 0672 2176)
8 Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK (GRID:grid.46699.34) (ISNI:0000 0004 0391 9020)
9 Chulalongkorn University Hospital, Bangkok, Thailand (GRID:grid.411628.8) (ISNI:0000 0000 9758 8584)
10 Formerly RG Kar Medical College and Institute of Neuroscience, Kolkata, India (GRID:grid.415622.6)
11 Nizam’s Institute of Medical Sciences, Hyderabad, India (GRID:grid.416345.1) (ISNI:0000 0004 1767 2356)
12 Vikram Hospitals, Center for Parkinson’s Disease and Movement Disorders Clinic, Bangalore, India (GRID:grid.416345.1); Parkinson’s Disease and Movement Disorders Clinic, Bangalore, India (GRID:grid.416345.1)
13 University of Santo Tomas Hospital, Manila, Philippines (GRID:grid.412777.0) (ISNI:0000 0004 0419 0374)
14 University of Sydney, ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, Sydney, Australia (GRID:grid.1013.3) (ISNI:0000 0004 1936 834X)
15 Westmead Hospital, Movement Disorders Unit, Neurology Department, Sydney, Australia (GRID:grid.413252.3) (ISNI:0000 0001 0180 6477); University of Sydney, Sydney Medical School, Sydney, Australia (GRID:grid.1013.3) (ISNI:0000 0004 1936 834X)
16 All India Institute of Medical Sciences, Department of Neurology, Cardiothoracic and Neurosciences Centre, New Delhi, India (GRID:grid.413618.9) (ISNI:0000 0004 1767 6103)
17 All India Institute of Medical Sciences, Department of Neurology, New Delhi, India (GRID:grid.413618.9) (ISNI:0000 0004 1767 6103)
18 Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India (GRID:grid.416257.3) (ISNI:0000 0001 0682 4092)
19 Interamerican Open University (CAECIHS-UAI), National Research Council (CONICET), Biomedical Research Center, Buenos Aires, Argentina (GRID:grid.441606.1) (ISNI:0000 0004 0489 6641); University of Buenos Aires, Department of Physiology, School of Medicine, Buenos Aires, Argentina (GRID:grid.7345.5) (ISNI:0000 0001 0056 1981)
20 Carlos III Institute of Health, Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain (GRID:grid.413448.e) (ISNI:0000 0000 9314 1427)