A longitudinal study of non-motor symptom burden in Parkinson's disease after a transition to expert care

Non-motor symptoms (NMS) are common among patients with Parkinson's disease (PD) however little is known about their progression in terms of severity or burden after referral to expert care.

This study was aimed to establish the progression of NMS burden in PD patients after referral to tertiary healthcare centre and factors affecting it.

Newly referred PD patients were prospectively enrolled and follow-up for up to 18 months. Non-motor symptoms scale (NMSS) was used to evaluate the burden of non-motor symptoms.

There was a significant median reduction of total NMS burden over the follow-up period. Similarly all NMS domains except domains 2 (sleep/fatigue), 3 (mood/cognition), 6 (gastrointestinal) and 7 (urinary) showed significant median reduction of scores. In the univariate regression analysis, Hoehn & Yahr staging, disease duration, visit, Schwab & England Activities of Daily Living score and UPDRS motor scores were individually predictive of change in total NMS burden. However, in the multivariable regression analysis only the latter three were significantly predictive of change in the total NMS burden.

There was a significant reduction of total NMS burden over the study period. The severity of motor and activity of daily living impairments as well as subsequent visit were the best predictors of NMS change.