86THE IMPACT OF MOTOR AND NON-MOTOR SYMPTOMS UPON HEALTH-RELATED QUALITY OF LIFE IN EARLY PARKINSON'S DISEASE: THE INCIDENCE OF COGNITIVE IMPAIRMENT IN COHORTS WITH LONGITUDINAL EVALUATION

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Abstract

Introduction: Non-motor symptoms (NMSs) are common in patients with established Parkinson's disease (PD). We aimed to determine the frequency and impact of NMS upon health-related quality-of-life (HRQoL) in early PD.

Methods: Patients with newly diagnosed PD attending neurology and geriatric medicine clinics in Newcastle and Gateshead were invited to participate. NMSs were assessed with the Non-Motor Symptom Questionnaire. HRQoL was measured with the Parkinson's Disease Quality of Life Questionnaire (PDQ-39). Additional assessments included: Movement Disorders Society revised Unified Parkinson's Disease Rating Scale part 3 (MDS-UPDRS-3); Geriatric Depression Scale-15; Mini-mental State Examination, Montreal Cognitive Assessment; Epworth Sleep Scale and Pittsburgh Sleep Quality Index.

Results: A total of 158 PD patients and 99 controls participated. The mean age of the PD patients was 66.5 ± 10.3 years, 105 (66.5%) were male, and disease duration was 6.3 ± 5.9 months. There were no differences in age, gender or education level between groups. PD patients reported more NMSs than controls (mean total = 8.4 ± 4.3 versus 2.8 ± 2.5, P < 0.001). Hypersalivation (56%), urinary urgency (47%), hyposmia (45%), anxiety (43.8%) and constipation (42%) were most frequent. Patients with tremor-dominant disease reported fewer NMS than patients with non-tremor-dominant disease (6.3 versus 9.3, P < 0.001).

Patients reported poorest HRQoL in PDQ-39 domains assessing bodily discomfort, mobility and activities of daily living (ADL). There was a significant correlation between total NMS reported and PDQ-39 score (P < 0.001). Depression (P < 0.001) and anxiety (P < 0.001) had greatest negative impact upon PDQ-39. Greater motor disability predicted higher PDQ-39 scores (P < 0.001). Patients with non-tremor-dominant disease reported reduced HRQoL in mobility (P < 0.001), ADL (P = 0.036) and bodily discomfort (P = 0.044) compared with tremor-dominant patients.

Conclusion: Motor and NMSs have a negative impact upon HRQoL in patients with early PD. NMS, particularly anxiety and depression are common and should not be ignored by clinicians caring for those with early PD.

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