Non-motor fluctuations in Parkinson's disease: frequency and clinical correlate

Non-motor symptoms (NMS) occur in 60-97% of Parkinson's disease (PD) patients. NMS show fluctuations over the course of the day referred to as non-motor fluctuations (NMF). To assess the frequency, severity, predictors and effect of the NMF on the quality of life in PD patients. This was a cross-sectional, hospital based, single-centre study. A total of 150 patients with PD were recruited. NMF was assessed using the MDS-Non-motor rating scale (MDS-NMS) and the Non-motor fluctuation assessment questionnaire (NoMoFA). The mean age at presentation and age at onset was 51.3 ± 10.8 years and 44.6 ± 11.1 years respectively and male predominance (75.3%). The mean duration of parkinsonism was 5.3 ± 3.7 years. Motor fluctuations (MF) were seen in 97 patients. A total of 143 patients (95.3%) had at least single NMS. Depression, cognition and pain was the most common NMS domain. NMF was seen in 57 patients (39.8%). NMF occurred in 50.5% in PD patients with MF. Pain was the most frequent NMS which showed NMF followed by fatigue, anxiety and depression. Pain had greater degree of change from ON to OFF period as compared to other NMS domains. NMF was associated with longer disease duration, higher levodopa dose and longer levodopa intake, greater motor severity, MF, higher NMS burden and poor quality of life. NMF is seen in association with MF. Pain, anxiety, depression and fatigue was the common NMS showing NMF. Pain had a large degree of fluctuation in the severity.