What are the most important nonmotor symptoms in patients with Parkinson's disease and are we missing them?
Identifieur interne : 001520 ( PubMed/Checkpoint ); précédent : 001519; suivant : 001521What are the most important nonmotor symptoms in patients with Parkinson's disease and are we missing them?
Auteurs : David A. Gallagher [Royaume-Uni] ; Andrew J. Lees ; Anette SchragSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2010.
English descriptors
- KwdEn :
- Aged, Autonomic Nervous System Diseases (complications), Depression (complications), Fatigue (complications), Female, Health Surveys, Humans, Male, Middle Aged, Parkinson Disease (complications), Parkinson Disease (diagnosis), Parkinson Disease (physiopathology), Quality of Life, Questionnaires, Severity of Illness Index, Sleep Disorders (complications).
- MESH :
- complications : Autonomic Nervous System Diseases, Depression, Fatigue, Parkinson Disease, Sleep Disorders.
- diagnosis : Parkinson Disease.
- physiopathology : Parkinson Disease.
- Aged, Female, Health Surveys, Humans, Male, Middle Aged, Quality of Life, Questionnaires, Severity of Illness Index.
Abstract
Nonmotor symptoms (NMS) are increasingly recognized as important and neglected aspects of Parkinson's disease (PD). We evaluated their relative frequency and comparative impact on health-related quality of life (Hr-QoL) using validated questionnaires. In addition, we assessed the rate of reporting of NMS in neurology clinics compared with their subjective impact on patients. We used a range of validated clinimetric scales of motor and nonmotor symptoms and Hr-QoL to assess consecutive patients with PD. Reporting of NMS was assessed by comparison with case note documentation. A mean of 11 of 30 NMS per patient were elicited on the NMS questionnaire of which on average 4.8 were reported in the clinical notes (44%). The most common NMS were autonomic (particularly urinary). The Hr-QoL scores correlated most strongly with autonomic dysfunction (r = 0.84; particularly urinary and gastrointestinal symptoms), mood (r = 0.74), fatigue (r = 0.74), sleep problems (nocturnal r = 0.55; daytime somnolence r = 0.65), pain (r = 0.56), and psychosis (r = 0.55, all p < 0.0001) followed by UPDRS motor score (r = 0.48, p < 0.0001). Greater motor fluctuations (r = 0.57) and dyskinesia (r = 0.43, both p < 0.0001) were also associated with worse Hr-QoL. In multivariate analysis, depression had the strongest association with Hr-QoL (adjusted R(2) = 0.53, p = 0.005) followed by fatigue, thermoregulatory, gastrointestinal, and cardiovascular autonomic function (especially orthostatic hypotension), daytime somnolence, and urinary problems. This study demonstrates that a autonomic dysfunction, psychiatric complications, pain, fatigue, and sleep problems are major correlates of poor Hr-QoL. However, whilst psychiatric problems are increasingly documented, many symptoms (particularly those possibly perceived as embarrassing or unrelated) remain under-reported.
DOI: 10.1002/mds.23394
PubMed: 20922807
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">What are the most important nonmotor symptoms in patients with Parkinson's disease and are we missing them?</title><author><name sortKey="Gallagher, David A" sort="Gallagher, David A" uniqKey="Gallagher D" first="David A" last="Gallagher">David A. Gallagher</name><affiliation wicri:level="3"><nlm:affiliation>Department of Clinical Neuroscience, Institute of Neurology, Royal Free Campus, London, United Kingdom.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Clinical Neuroscience, Institute of Neurology, Royal Free Campus, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Lees, Andrew J" sort="Lees, Andrew J" uniqKey="Lees A" first="Andrew J" last="Lees">Andrew J. Lees</name></author><author><name sortKey="Schrag, Anette" sort="Schrag, Anette" uniqKey="Schrag A" first="Anette" last="Schrag">Anette Schrag</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2010">2010</date><idno type="doi">10.1002/mds.23394</idno><idno type="RBID">pubmed:20922807</idno><idno type="pmid">20922807</idno><idno type="wicri:Area/PubMed/Corpus">001541</idno><idno type="wicri:Area/PubMed/Curation">001541</idno><idno type="wicri:Area/PubMed/Checkpoint">001520</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">What are the most important nonmotor symptoms in patients with Parkinson's disease and are we missing them?</title><author><name sortKey="Gallagher, David A" sort="Gallagher, David A" uniqKey="Gallagher D" first="David A" last="Gallagher">David A. Gallagher</name><affiliation wicri:level="3"><nlm:affiliation>Department of Clinical Neuroscience, Institute of Neurology, Royal Free Campus, London, United Kingdom.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Clinical Neuroscience, Institute of Neurology, Royal Free Campus, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Lees, Andrew J" sort="Lees, Andrew J" uniqKey="Lees A" first="Andrew J" last="Lees">Andrew J. Lees</name></author><author><name sortKey="Schrag, Anette" sort="Schrag, Anette" uniqKey="Schrag A" first="Anette" last="Schrag">Anette Schrag</name></author></analytic><series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title><idno type="eISSN">1531-8257</idno><imprint><date when="2010" type="published">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Autonomic Nervous System Diseases (complications)</term><term>Depression (complications)</term><term>Fatigue (complications)</term><term>Female</term><term>Health Surveys</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Parkinson Disease (complications)</term><term>Parkinson Disease (diagnosis)</term><term>Parkinson Disease (physiopathology)</term><term>Quality of Life</term><term>Questionnaires</term><term>Severity of Illness Index</term><term>Sleep Disorders (complications)</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Autonomic Nervous System Diseases</term><term>Depression</term><term>Fatigue</term><term>Parkinson Disease</term><term>Sleep Disorders</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Female</term><term>Health Surveys</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Quality of Life</term><term>Questionnaires</term><term>Severity of Illness Index</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Nonmotor symptoms (NMS) are increasingly recognized as important and neglected aspects of Parkinson's disease (PD). We evaluated their relative frequency and comparative impact on health-related quality of life (Hr-QoL) using validated questionnaires. In addition, we assessed the rate of reporting of NMS in neurology clinics compared with their subjective impact on patients. We used a range of validated clinimetric scales of motor and nonmotor symptoms and Hr-QoL to assess consecutive patients with PD. Reporting of NMS was assessed by comparison with case note documentation. A mean of 11 of 30 NMS per patient were elicited on the NMS questionnaire of which on average 4.8 were reported in the clinical notes (44%). The most common NMS were autonomic (particularly urinary). The Hr-QoL scores correlated most strongly with autonomic dysfunction (r = 0.84; particularly urinary and gastrointestinal symptoms), mood (r = 0.74), fatigue (r = 0.74), sleep problems (nocturnal r = 0.55; daytime somnolence r = 0.65), pain (r = 0.56), and psychosis (r = 0.55, all p < 0.0001) followed by UPDRS motor score (r = 0.48, p < 0.0001). Greater motor fluctuations (r = 0.57) and dyskinesia (r = 0.43, both p < 0.0001) were also associated with worse Hr-QoL. In multivariate analysis, depression had the strongest association with Hr-QoL (adjusted R(2) = 0.53, p = 0.005) followed by fatigue, thermoregulatory, gastrointestinal, and cardiovascular autonomic function (especially orthostatic hypotension), daytime somnolence, and urinary problems. This study demonstrates that a autonomic dysfunction, psychiatric complications, pain, fatigue, and sleep problems are major correlates of poor Hr-QoL. However, whilst psychiatric problems are increasingly documented, many symptoms (particularly those possibly perceived as embarrassing or unrelated) remain under-reported.</div></front></TEI><pubmed><MedlineCitation Owner="NLM" Status="MEDLINE"><PMID Version="1">20922807</PMID><DateCreated><Year>2010</Year><Month>11</Month><Day>11</Day></DateCreated><DateCompleted><Year>2011</Year><Month>02</Month><Day>25</Day></DateCompleted><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1531-8257</ISSN><JournalIssue CitedMedium="Internet"><Volume>25</Volume><Issue>15</Issue><PubDate><Year>2010</Year><Month>Nov</Month><Day>15</Day></PubDate></JournalIssue><Title>Movement disorders : official journal of the Movement Disorder Society</Title><ISOAbbreviation>Mov. Disord.</ISOAbbreviation></Journal><ArticleTitle>What are the most important nonmotor symptoms in patients with Parkinson's disease and are we missing them?</ArticleTitle><Pagination><MedlinePgn>2493-500</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1002/mds.23394</ELocationID><Abstract><AbstractText>Nonmotor symptoms (NMS) are increasingly recognized as important and neglected aspects of Parkinson's disease (PD). We evaluated their relative frequency and comparative impact on health-related quality of life (Hr-QoL) using validated questionnaires. In addition, we assessed the rate of reporting of NMS in neurology clinics compared with their subjective impact on patients. We used a range of validated clinimetric scales of motor and nonmotor symptoms and Hr-QoL to assess consecutive patients with PD. Reporting of NMS was assessed by comparison with case note documentation. A mean of 11 of 30 NMS per patient were elicited on the NMS questionnaire of which on average 4.8 were reported in the clinical notes (44%). The most common NMS were autonomic (particularly urinary). The Hr-QoL scores correlated most strongly with autonomic dysfunction (r = 0.84; particularly urinary and gastrointestinal symptoms), mood (r = 0.74), fatigue (r = 0.74), sleep problems (nocturnal r = 0.55; daytime somnolence r = 0.65), pain (r = 0.56), and psychosis (r = 0.55, all p < 0.0001) followed by UPDRS motor score (r = 0.48, p < 0.0001). Greater motor fluctuations (r = 0.57) and dyskinesia (r = 0.43, both p < 0.0001) were also associated with worse Hr-QoL. In multivariate analysis, depression had the strongest association with Hr-QoL (adjusted R(2) = 0.53, p = 0.005) followed by fatigue, thermoregulatory, gastrointestinal, and cardiovascular autonomic function (especially orthostatic hypotension), daytime somnolence, and urinary problems. This study demonstrates that a autonomic dysfunction, psychiatric complications, pain, fatigue, and sleep problems are major correlates of poor Hr-QoL. 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Lees</name><name sortKey="Schrag, Anette" sort="Schrag, Anette" uniqKey="Schrag A" first="Anette" last="Schrag">Anette Schrag</name></noCountry><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Gallagher, David A" sort="Gallagher, David A" uniqKey="Gallagher D" first="David A" last="Gallagher">David A. Gallagher</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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