The impact of non-motor symptoms on the Health-Related Quality of Life of Parkinson's disease patients from Southwest China

https://doi.org/10.1016/j.parkreldis.2013.10.005Get rights and content

Abstract

Background

The impact of non-motor symptoms (NMS) on the Health-Related Quality of Life (HRQoL) of patients with Parkinson's disease (PD) in the Chinese population are largely unknown.

Objectives

To study the impact of NMS on the HRQoL in Chinese PD patients.

Methods

A total of 693 PD patients from Southwest China were included in the study. NMS of patients were evaluated by non-motor symptoms scale (NMSS) and Parkinson's disease questionnaire-39 item version (PDQ-39) was used to evaluate the HRQoL of PD.

Results

The mean total score of NMSS was 37.2 ± 33.0 and the most prevalent NMS domain was sleep/fatigue (79.8%). There was a significant strong positive correlation between total NMSS score (rs = 0.71, P < 0.01), sleep/fatigue domain (rs = 0.60, P < 0.01) and PDQ-39 SI. Mood/apathy (rs = 0.55, P < 0.01), attention/memory (rs = 0.42, P < 0.01), gastrointestinal (rs = 0.44, P < 0.01) and Miscellany domains (rs = 0.46, P < 0.01) moderately correlated with PDQ-39 SI. A strong correlation was found between PDQ-39 SI (rs = 0.71, P < 0.01), emotional well-being (rs = 0.62, P < 0.01), cognitions (rs = 0.62, P < 0.01), and the total score of NMSS. Moderate correlation was found between mobility (rs = 0.45, P < 0.01), activities of daily living (rs = 0.43, P < 0.01), stigma (rs = 0.42, P < 0.01), communication (rs = 0.47, P < 0.01), bodily discomfort (rs = 0.46, P < 0.01) and the total score of NMSS. Female, H–Y stage, UPDRS-III and NMSS total score were the potential determinants of worse HRQoL of PD patients.

Conclusions

NMS have close association with various aspects of the HRQoL. Severe NMS may be related to dramatic decline of the HRQoL of PD patients.

Introduction

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by cardinal motor symptoms including tremor, rigidity, bradykinesia and postural instability. PD affects approximately 1.7% population aged 65 years and over in mainland China [1]. Recently, increasing evidence suggests that PD has numerous non-motor symptoms (NMS) which include: neuropsychiatric symptoms, sleep disorders, autonomic and sensory symptoms [2]. NMS have been found not only in the advanced stage but also in the early stage of the disease, and may precede the onset of motor symptoms by several years [3]. NMS are often under-recognized and poorly managed in clinical practice [4]. NMS also impair quality of life of PD patients and leads to institutionalization, which imposes a considerable economic burden on PD patients' families and society [2], [5], [6].

Health-Related Quality of Life (HRQoL) may be defined as the perception and self-evaluation by patients of the disease's impact on their life and its consequences [7]. The evaluation of HRQoL is important in patients with PD, as the information gained from it can lead to a better understanding of the disease's consequences and suggest optimum treatment. In the past 20 years, the impact of motor symptoms such as rigidity, bradykinesia, tremor, gait and impaired balance on the decline of HRQoL has been well understood [8], [9], [10], [11]. Recently, the impact of NMS on the HRQoL of PD patients has attracted substantial attention. Many studies from the West have reported that NMS play a more important role in the decline of HRQoL than motor symptoms [12], [13], [14], [15]. The correlation between NMS and HRQoL in PD may differ among populations of different ethnic, economic, cultural and educational background. There are two studies on the correlation between NMS and HRQoL of PD in the Chinese populations of Beijing and Guangzhou, which demonstrated that mood, sleep/fatigue, gastrointestinal and urinary symptoms played a key role in the impact on HRQoL [5], [16]; however, the sample sizes of these two studies were small. Therefore, we performed a study that included 693 PD patients from Southwest China to analyze the association between NMS and HRQoL of PD in a large sample.

Section snippets

Patients and methods

This cross-sectional and observational study included 693 PD patients consecutively admitted to hospital or seen in the outpatient clinic in the Department of Neurology, West China Hospital of SiChuan University between January 2009 and March 2013. All the patients met the UK PD Brain Bank criteria for PD [17]. The clinical information including age, age at onset, gender and anti-Parkinson medication were collected by neurologists during face-to face interviews. The Unified Parkinson's Disease

Statistical analysis

The continuous variables including age, onset age, UPDRS-III, score of NMSS and PDQ-39 SI are presented as mean ± standard deviation (SD). H–Y staging is presented as median and interquartile range, while the categorical variables such as gender and prevalence of NMS are shown as a percentage. As the total score and scores of each domain of NMSS, scores of each domain of PDQ-39 SI were not distributed normally using Kolmogorov–Smirnov and Shapiro–Wilk tests, Spearman's correlation test was used

Results

Of the 693 PD patients, 386 were male and 307 were female. The mean age was 61.5 ± 11.4 years and the mean age of onset was 57.1 ± 11.4 years. The mean disease duration was 4.4 ± 4.2 years. The mean score of UPDRS-III was 30.2 ± 13.4 and the median H–Y stage was 2.5 (1.0). A total of 185 patients (26.7%) presented with motor fluctuation and 40 patients (5.8%) presented with dyskinesia. The mean daily dose of levodopa was 209.0 ± 229.6 mg. The proportion of patients receiving treatment of

Discussion

To our knowledge, this is the first large sample study that focused on the association between NMS and HRQoL in the Chinese PD population. In this study, we found that NMS are prevalent in our PD patients. The most common NMS was sleep/fatigue, which is in accord with some other studies [22], [23]. These findings indicate that nuclei of the brain responsible for regulating and controlling sleep may be more susceptible to degeneration in PD [24].

Moderate positive correlation between total NMSS

Conclusions

NMS are prevalent in Chinese PD patients. NMS have a close association with various aspects of the HRQoL and severe NMS may be related to decline in the HRQoL of PD patients. Early detection and treatment of these NMS could help to improve HRQoL of PD patients.

Acknowledgments

The authors thank the patients for their participation in the study.

References (31)

  • H. Li et al.

    Nonmotor symptoms are independently associated with impaired health-related quality of life in Chinese patients with Parkinson's disease

    Mov Disord

    (2010)
  • G. Wang et al.

    Economic burden of Parkinson's disease in a developing country: a retrospective cost analysis in Shanghai, China

    Mov Disord

    (2006)
  • P. Martinez-Martin

    An introduction to the concept of “quality of life in Parkinson's disease”

    J Neurol

    (1998)
  • K.A. Grosset et al.

    Patient-perceived involvement and satisfaction in Parkinson's disease: effect on therapy decisions and quality of life

    Mov Disord

    (2005)
  • S. Chapuis et al.

    Impact of the motor complications of Parkinson's disease on the quality of life

    Mov Disord

    (2005)
  • Cited by (55)

    • An SBM-based machine learning model for identifying mild cognitive impairment in patients with Parkinson's disease

      2020, Journal of the Neurological Sciences
      Citation Excerpt :

      Parkinson's disease (PD) is one of the most common movement disorders and the second most common neurodegenerative condition [1]. Besides motor features, PD is associated with a wide range of non-motor symptoms, including cognitive impairment, depression, anxiety, sleep disorders, autonomic failure and so on, which may occur far early before the onset [2–5]. According to a previous study, up to 80% of patients with PD develop dementia [6].

    • Non-motor symptoms depending on motor severity in Japanese patients with Parkinson's disease: A multicenter cross-sectional study

      2020, Journal of the Neurological Sciences
      Citation Excerpt :

      Diagnoses and severity classifications in Parkinson's disease (PD) are defined based on motor symptoms (MS), where the majority of PD treatment is focused [1,2]. However, non-motor symptoms (NMS) [3,4] have a greater impact on reducing the Quality of life (QOL) of PD patients compared with MS [5–12]. The results of several studies have led to the notion that NMS must be also therapeutically addressed with appropriate measures [13].

    View all citing articles on Scopus
    1

    These two authors have contributed equally to the work.

    View full text