Prevalence of non-motor symptoms in Parkinson’s disease

Shakthi C., Sritharan B., Muthuveeran M., Manivannan M. R., Justin C., GanesaPandian D.


Background: Parkinson’s disease is a common neurodegenerative movement disorder characterised by motor symptoms of rest tremor, bradykinesia, rigidity and postural instability and non-motor symptoms (NMS) which include neuropsychiatric symptoms, sleep disturbances, autonomic symptoms, sensory symptoms and symptoms of mixed aetiology. Parkinson’s Disease Non Motor Group (PD-NMG) devised a comprehensive clinic-based self-completed NMS questionnaire that allows easy identification of NMS by the physician. Most NMS have a poor response to dopaminergic therapy as it is due to dysfunction of the serotonergic and noradrenergic pathways. Treatment of these nonmotor symptoms help in improving the quality of life in patients with Parkinson’s disease.

Methods: There were 100 patients with Parkinson’s disease who had presented to our neuromedicine movement clinic were included in the study. Patients were diagnosed as PD based on UK Parkinson’s disease brain bank criteria. The inclusion criteria were diagnosis as PD, age >18 yrs, inclusion of both males and females and consent for the study. Patients with atypical parkinsonism and secondary parkinsonism, stroke, intake of antipsychotics were excluded from the study. Non motor symptom questionnaire was given to the study group and frequency of occurrence of each non motor symptoms and their predominance in both males and females were studied. The frequency of each NMS was calculated by computing the number of yes response and calculating the percentage related to the number of patients in the sample. Analysis was done to calculate the frequency of all NMS among the enrolled patient.

Results: Nocturnal sleep disturbances (43%) were most common followed by constipation (29%).The most common non motor symptoms in males were constipation (20%), urinary urgency (18%) and nocturia (11%).The most common non motor symptoms in females were nocturnal sleep disturbance (25%), feeling sad (19%), unexplained pains (17%) and being anxious (13%).

Conclusions: Non motor symptom questionnaire helps in screening patients with Parkinson’s disease of non-motor symptoms and aims at providing holistic treatment improving the quality of life.


Nonmotor symptoms questionnaire, Parkinson’s disease

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Parkinson J. An essay on the shaking palsy. 224 J Neuropsychiatry Clin Neurosci. 2002;14:2.

Mitra K, Gangopadhyaya PK, Das SK. Parkinsonism plus syndromes-A review. Neurology India. 2003;5:183-8.

De Lau LM, Breteler MM. Epidemiology of Parkinson’s disease. Lancet Neurol. 2006;5:525-35.

Behari M. Treatment of Parkinson’s disease: fighting the surging enemy. Neurol India. 1999;47:259-62.

Chaudhuri KR, Healy DG, Schapira AHV. Non-motor symptoms of Parkinson’s disease: diagnosis and management. Lancet Neurol. 2006;5:235-45.

Chaudhuri KR, Naidu Y. Early Parkinson’s disease and non-motor issues. J Neurol. 2008;255:33-8.

Braak H, Rub U, Jansen Steur EN, Del Tredici K, de Vos RA. Cognitive status correlates with neuropathologic stage in Parkinson disease. Neurol. 2005;64:1404-10.

Forsaa EB, Larsen JP, Wentzel-Larsen T, Herlofson K, Alves G. Predictors and course of health-related quality of life in Parkinson's disease. Mov Dis. 2008;23:1420-7.

Chaudhuri KR, Prieto-Jurcynska C, Naidu Y, Mitra T, Frades-Payo B, Tluk S, et al. The nondeclaration of nonmotor symptoms of Parkinson's disease to health care professionals: An international study using the nonmotor symptoms questionnaire. Mov Dis. 2010;25:704-9.

Chaudhuri KR, Martinez-Martin P, Schapira AH, Stocchi F, Sethi K, Odin P, et al. International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: The NMS Quest study. Mov Dis. 2006;21:9.

Martinez-Martin P, Schapira AH, Stocchi F, Sethi K, Odin P, MacPhee G, et al. Prevalence of nonmotor symptoms in Parkinson's disease in an international setting; Study using nonmotor symptoms questionnaire in 545 patients. Mov Disord. 2007;22:1623-9.

Krishnan S, Sarma G, Sarma S, Kishore A. Do nonmotor symptoms in Parkinson's disease differ from normal aging. Mov Dis. 2011;26:2110-3.

Barone P, Antonini A, Colosimo C, Marconi R, Morgante L, Avarello TP, et al. PRIAMO study group. The PRIAMO study: A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease. Mov Dis. 2009;24:1641-9.

Ravan A, Ahmad FM, Chabria S, Gadhari M, Sankhla CS. Non-motor symptoms in an Indian cohort of Parkinson's disease patients and correlation of progression of non-motor symptoms with motor worsening. Neurology India. 2015 Mar 1;63(2):166-74.

Mukhtar S, Imran R, Zaheer M, Tariq H. Frequency of non-motor symptoms in Parkinson’s disease presenting to tertiary care centre in Pakistan: an observational, cross-sectional study. BMJ open. 2018 May 1;8(5):e019172.

Korczyn AD. Autonomic nervous system disturbances in Parkinson’s disease. Adv Neurol. 1990;53:463-8.

Cummings JL. Depression and Parkinson‘s disease: a review. Am J Psychiatry. 1992;149:443-54.