MNCD: A New Tool for Classifying Parkinson’s Disease in Daily Clinical Practice

Background and objective: Parkinson’s disease (PD) is a clinically heterogeneous disorder in which the symptoms and prognosis can be very different among patients. We propose a new simple classification to identify key symptoms and staging in PD. Patients and Methods: Sixteen movement disorders specialists from Spain participated in this project. The classification was consensually approved after a discussion and review process from June to October 2021. The TNM classification and the National Institutes of Health Stroke Scale (NIHSS) were considered as models in the design. Results: The classification was named MNCD and included 4 major axes: (1) motor symptoms; (2) non-motor symptoms; (3) cognition; (4) dependency for activities of daily living (ADL). Motor axis included 4 sub-axes: (1) motor fluctuations; (2) dyskinesia; (3) axial symptoms; (4) tremor. Four other sub-axes were included in the non-motor axis: (1) neuropsychiatric symptoms; (2) autonomic dysfunction; (3) sleep disturbances and fatigue; (4) pain and sensory disorders. According to the MNCD, 5 stages were considered, from stage 1 (no disabling motor or non-motor symptoms with normal cognition and independency for ADL) to 5 (dementia and dependency for basic ADL). Conclusions: A new simple classification of PD is proposed. The MNCD classification includes 4 major axes and 5 stages to identify key symptoms and monitor the evolution of the disease in patients with PD. It is necessary to apply this proof of concept in a properly designed study.

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Alexithymia and Apathy in Parkinson’s Disease: Neurocognitive Correlates

Behavioural Neurology ◽

10.1155/2013/682393 ◽

2013 ◽

Vol 27 (4) ◽

pp. 535-545 ◽

Cited By ~ 14

Author(s):

Yelena Bogdanova ◽

Alice Cronin-Golomb

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Neuropsychological Tests ◽

Emotional Processing ◽

Rating Scales ◽

Right Hemisphere ◽

Neuropsychiatric Symptoms ◽

Disease Stage ◽

Motor Symptoms ◽

Non Motor Symptoms

Non-motor symptoms such as neuropsychiatric and cognitive dysfunction have been found to be common in Parkinson’s disease (PD) but the relation between such symptoms is poorly understood. We focused on alexithymia, an impairment of affective and cognitive emotional processing, as there is evidence for its interaction with cognition in other disorders. Twenty-two non-demented PD patients and 22 matched normal control adults (NC) were administered rating scales assessing neuropsychiatric status, including alexithymia, apathy, and depression, and a series of neuropsychological tests. As expected, PD patients showed more alexithymia than NC, and there was a significant association between alexithymia and disease stage. Alexithymia was associated with performance on non-verbally mediated measures of executive and visuospatial function, but not on verbally mediated tasks. By contrast, there was no correlation between cognition and ratings of either depression or apathy. Our findings demonstrate a distinct association of alexithymia with non-verbal cognition in PD, implicating right hemisphere processes, and differentiate between alexithymia and other neuropsychiatric symptoms in regard to PD cognition.

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Hyposmia as a marker of (non-)motor disease severity in Parkinson’s disease

Journal of Neural Transmission ◽

10.1007/s00702-019-02074-0 ◽

2019 ◽

Vol 126 (11) ◽

pp. 1471-1478 ◽

Cited By ~ 7

Author(s):

Dareia S. Roos ◽

Jos W. R. Twisk ◽

Pieter G. H. M. Raijmakers ◽

Richard L. Doty ◽

Henk W. Berendse

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Disturbances ◽

Psychiatric Symptoms ◽

Cell Loss ◽

Motor Symptoms ◽

Dopaminergic Cell ◽

Dat Spect ◽

Spect Scan ◽

Non Motor Symptoms

Abstract The aim of this study was to evaluate the relationship of hyposmia in Parkinson’s disease (PD) with other motor and non-motor symptoms and with the degree of nigrostriatal dopaminergic cell loss. A total of 295 patients with a diagnosis of PD were included. Olfactory function was measured using the University of Pennsylvania Smell Identification Test (UPSIT). Motor symptoms were rated using the Unified Parkinson’s Disease Rating Scale motor subscale (UPDRS III). To evaluate other non-motor symptoms, we used the Mini-Mental State Examination (MMSE) as a measure of global cognitive function and validated questionnaires to assess sleep disturbances, psychiatric symptoms, and autonomic dysfunction. A linear regression model was used to calculate correlation coefficients between UPSIT score and motor and non-motor variables [for psychiatric symptoms a Poisson regression was performed]. In a subgroup of patients (n = 155) with a dopamine transporter (DaT) SPECT scan, a similar statistical analysis was performed, now including striatal DaT binding. In the regression models with correction for age, sex, disease duration, and multiple testing, all motor and non-motor symptoms were associated with UPSIT scores. In the subgroup of patients with a DaT-SPECT scan, there was a strong association between olfactory test scores and DaT binding in both putamen and caudate nucleus. Hyposmia in PD is associated with various motor and non-motor symptoms, like cognition, depression, anxiety, autonomic dysfunction and sleep disturbances, and with the degree of nigrostriatal dopaminergic cell loss. This finding adds further confirmation that hyposmia holds significant promise as a marker of disease progression.

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Stress and mindfulness in Parkinson’s disease – a survey in 5000 patients

npj Parkinson s Disease ◽

10.1038/s41531-020-00152-9 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Anouk van der Heide ◽

Anne E. M. Speckens ◽

Marjan J. Meinders ◽

Liana S. Rosenthal ◽

Bastiaan R. Bloem ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Perceived Stress ◽

Online Survey ◽

Neuropsychiatric Symptoms ◽

Motor Symptoms ◽

Dispositional Mindfulness ◽

Mindfulness Skills ◽

Self Compassion ◽

Non Motor Symptoms

AbstractMany Parkinson’s disease (PD) patients notice that motor symptoms worsen during stress, and experience stress-related neuropsychiatric symptoms such as anxiety and depression. Here we investigated which personal and disease characteristics are associated with perceived stress in PD, which PD symptoms are sensitive to stress, and we assessed self-reported benefits of stress-reducing strategies such as mindfulness. We sent an online survey to the Fox Insight cohort (n = 28,385 PD patients, n = 11,413 healthy controls). The survey included specific questions about the influence of stress on PD symptoms, use of stress-reducing strategies, and several validated scales measuring perceived stress, anxiety, dispositional mindfulness, rumination, and self-compassion. We received completed surveys from 5000 PD patients and 1292 controls. Patients perceived more stress than controls. Among patients, stress was correlated with increased rumination (R = 0.65), lower quality of life (R = −0.56), lower self-compassion (R = −0.65), and lower dispositional mindfulness (R = −0.48). Furthermore, patients indicated that stress significantly worsened both motor symptoms – especially tremor – and non-motor symptoms. Physical exercise was most frequently used to reduce stress (83.1%). Mindfulness was practiced by 38.7% of PD respondents, who noticed improvement in both motor and non-motor symptoms. Among non-users, 43.4% were interested in gaining mindfulness skills. We conclude that PD patients experience greater levels of stress than controls, and that stress worsens both motor and non-motor symptoms. Mindfulness may improve PD symptom severity, with the strongest effects on anxiety and depressed mood. These findings justify further controlled studies to establish the merits of mindfulness and other stress-alleviating interventions.

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Polysomnographic correlates of sleep disturbances in de novo, drug naïve Parkinson’s Disease

Neurological Sciences ◽

10.1007/s10072-021-05622-3 ◽

2021 ◽

Author(s):

Beatrice Orso ◽

Francesco Famà ◽

Laura Giorgetti ◽

Pietro Mattioli ◽

Andrea Donniaquio ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Disturbances ◽

De Novo ◽

Sleep Onset ◽

Inverse Correlation ◽

Motor Symptoms ◽

Periodic Leg Movements ◽

Drug Naïve ◽

Non Motor Symptoms

Abstract Background Sleep disturbances are common non-motor symptoms of Parkinson’s Disease (PD). Methods The aim of this study was to investigate the polysomnographic correlates of sleep changes, as investigated by the Parkinson’s Disease Sleep Scale-2 (PDSS-2), in a cohort of sixty-two consecutive de novo, drug naïve PD patients (71.40 ± 7.84 y/o). Results PDSS-2 total score showed a direct correlation with stage shifts (p = 0.008). Fragmented sleep showed an inverse correlation with sleep efficiency (p = 0.012). Insomnia symptoms showed an inverse correlation with wake after sleep onset (p = 0.005) and direct correlation with periodic leg movements (p = 0.006) and stage shift indices (p = 0.003). Motor Symptoms showed a direct correlation with Apnoea-Hypopnoea (AHI; p = 0.02) and awakenings indices (p = 0.003). Dream distressing showed a direct correlation with REM without atonia (RWA, p = 0.042) and an inverse correlation with AHI (p = 0.012). Sleep quality showed an inverse correlation with RWA (p = 0.008). Conclusion PDSS-2 features are significantly correlated with polysomnography objective findings, thus further supporting its reliability to investigate sleep disturbances in PD patients.

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Prevalence of non-motor symptoms in Parkinson’s disease

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191488 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1459

Author(s):

Shakthi C. ◽

Sritharan B. ◽

Muthuveeran M. ◽

Manivannan M. R. ◽

Justin C. ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Disturbances ◽

Motor Symptom ◽

Motor Symptoms ◽

Nocturnal Sleep ◽

Males And Females ◽

Non Motor Symptoms

Background: Parkinson’s disease is a common neurodegenerative movement disorder characterised by motor symptoms of rest tremor, bradykinesia, rigidity and postural instability and non-motor symptoms (NMS) which include neuropsychiatric symptoms, sleep disturbances, autonomic symptoms, sensory symptoms and symptoms of mixed aetiology. Parkinson’s Disease Non Motor Group (PD-NMG) devised a comprehensive clinic-based self-completed NMS questionnaire that allows easy identification of NMS by the physician. Most NMS have a poor response to dopaminergic therapy as it is due to dysfunction of the serotonergic and noradrenergic pathways. Treatment of these nonmotor symptoms help in improving the quality of life in patients with Parkinson’s disease.Methods: There were 100 patients with Parkinson’s disease who had presented to our neuromedicine movement clinic were included in the study. Patients were diagnosed as PD based on UK Parkinson’s disease brain bank criteria. The inclusion criteria were diagnosis as PD, age >18 yrs, inclusion of both males and females and consent for the study. Patients with atypical parkinsonism and secondary parkinsonism, stroke, intake of antipsychotics were excluded from the study. Non motor symptom questionnaire was given to the study group and frequency of occurrence of each non motor symptoms and their predominance in both males and females were studied. The frequency of each NMS was calculated by computing the number of yes response and calculating the percentage related to the number of patients in the sample. Analysis was done to calculate the frequency of all NMS among the enrolled patient.Results: Nocturnal sleep disturbances (43%) were most common followed by constipation (29%).The most common non motor symptoms in males were constipation (20%), urinary urgency (18%) and nocturia (11%).The most common non motor symptoms in females were nocturnal sleep disturbance (25%), feeling sad (19%), unexplained pains (17%) and being anxious (13%).Conclusions: Non motor symptom questionnaire helps in screening patients with Parkinson’s disease of non-motor symptoms and aims at providing holistic treatment improving the quality of life.

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Dopamine-Induced Nonmotor Symptoms of Parkinson's Disease

Parkinson s Disease ◽

10.4061/2011/485063 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Ariane Park ◽

Mark Stacy

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Side Effects ◽

Sleep Disturbances ◽

Complex Disease ◽

Sleep Problems ◽

Motor Symptoms ◽

Nonmotor Symptoms ◽

Neuropsychiatric Complications ◽

Non Motor Symptoms

Nonmotor symptoms of Parkinson's disease (PD) may emerge secondary to the underlying pathogenesis of the disease, while others are recognized side effects of treatment. Inevitably, there is an overlap as the disease advances and patients require higher dosages and more complex medical regimens. The non-motor symptoms that emerge secondary to dopaminergic therapy encompass several domains, including neuropsychiatric, autonomic, and sleep. These are detailed in the paper. Neuropsychiatric complications include hallucinations and psychosis. In addition, compulsive behaviors, such as pathological gambling, hypersexuality, shopping, binge eating, and punding, have been shown to have a clear association with dopaminergic medications. Dopamine dysregulation syndrome (DDS) is a compulsive behavior that is typically viewed through the lens of addiction, with patients needing escalating dosages of dopamine replacement therapy. Treatment side effects on the autonomic system include nausea, orthostatic hypotension, and constipation. Sleep disturbances include fragmented sleep, nighttime sleep problems, daytime sleepiness, and sleep attacks. Recognizing the non-motor symptoms that can arise specifically from dopamine therapy is useful to help optimize treatment regimens for this complex disease.

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The Effect of Non-motor Symptoms on Quality of Life in Parkinson's Disease

European Neurological Review ◽

10.17925/enr.2009.04.02.29 ◽

2009 ◽

Vol 4 (2) ◽

pp. 29 ◽

Cited By ~ 2

Author(s):

Claire Hinnell ◽

K Ray Chaudhuri ◽

◽

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Disturbances ◽

Motor Symptoms ◽

Neuropsychiatric Complications ◽

Significant Burden ◽

The Impact ◽

Non Motor Symptoms

Non-motor symptoms (NMS) are common in Parkinson’s disease (PD), affecting up to 90% of patients during their illness, and include neuropsychiatric complications, autonomic disorders, sleep disturbances and sensory symptoms. Although NMS correlate strongly with advancing disease, they may precede the onset of motor symptoms by a number of years. It is increasingly recognised that NMS result in a significant burden for people with PD and affect quality of life (QoL) to a greater extent than motor features. However, NMS often remain undiagnosed and untreated. Herein we review the impact of common NMS on QoL for patients with PD.

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NON MOTOR SYMPTOMS IN PARKINSON’S DISEASE PATIENTS: A HOSPITAL BASED PROSPECTIVE STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i10.665 ◽

2019 ◽

Vol 3 (10) ◽

Author(s):

Dr. Atul Baid ◽

Dr. Chhavi Raman Baid

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Neuropsychiatric Symptoms ◽

Gastrointestinal Symptoms ◽

Motor Symptoms ◽

Yahr Stage ◽

Brain Bank ◽

Unexplained Pain ◽

Office Software ◽

Non Motor Symptoms

Objectives: This present study was to evaluate the clinical profile and prevalence of non motor symptoms in Parkinson’s disease patients on the basis of various system involvements. Methods: Detail history, clinical examination and relevant investigations were performed to all cases of Parkinson’s disease patients. The diagnosis of Parkinson’s disease was confirmed by UKPDS Brain Bank Criteria. Neurological examination was conducted for MMSE scores and H and Y staging. Results: Data was analyzed by using simple statistical methods with help of Ms-Office software. Data was tabulated and percentages were calculated. Conclusions: Parkinson’s disease was commonly occurred in old age male populations. Most of the cases had H & Y stage 2. Non motor symptoms were progressed as the stage of Parkinson’s disease progressed. Nausea, unsatisfactory bowel voiding and constipation were common gastrointestinal symptoms. Decreased libido, orthostatic hypotension, nocturia and hypo/hyper Sexuality were common autonomic dysfunction. Insomnia, Restless Leg and Behavioural limb movements were common sleep disorders. Dementia, attention deficit, anhedonia and apathy were common neuropsychiatric symptoms seen in patients with Parkinson’s disease. Common sensory symptoms were unexplained Pain (Paraesthesia) and hyposmia. Other common symptoms of Parkinson’s disease patients had swelling of leg, falls and weight gain. Hence early diagnosis, management and awareness are essential for improvement of quality of life of patients with Parkinson’s disease. Keywords: Parkinson’s disease, non motor symptoms, Hoehn & Yahr stage, UKPDS Brain Bank Criteria

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Sleep disturbances and gastrointestinal dysfunction are associated with thalamic atrophy in Parkinson’s disease

BMC Neuroscience ◽

10.1186/s12868-019-0537-1 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Flavia Niccolini ◽

Heather Wilson ◽

Beniamino Giordano ◽

Konstantinos Diamantopoulos ◽

Gennaro Pagano ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Gastrointestinal Tract ◽

Cortical Thickness ◽

Sleep Disturbances ◽

Sensory Information ◽

Motor Symptom ◽

Motor Symptoms ◽

Subcortical Nuclei ◽

Non Motor Symptoms

Abstract Background Non-motor symptoms are common aspects of Parkinson’s disease (PD) occurring even at the prodromal stage of the disease and greatly affecting the quality of life. Here, we investigated whether non-motor symptoms burden was associated with cortical thickness and subcortical nuclei volume in PD patients. Methods We studied 41 non-demented PD patients. Non-motor symptoms burden was assessed using the Non-Motor Symptoms Scale grading (NMSS). Cortical thickness and subcortical nuclei volume analyses were carried out using Free-Surfer. PD patients were divided into two groups according to the NMSS grading: mild to moderate (NMSS: 0–40) and severe (NMSS: ≥ 41) non-motor symptoms. Results Thalamic atrophy was associated with higher NMSQ and NMSS total scores. The non-motor symptoms that drove this correlation were sleep/fatigue and gastrointestinal tract dysfunction. We also found that PD patients with severe non-motor symptoms had significant thalamic atrophy compared to the group with mild to moderate non-motor symptoms. Conclusions Our findings show that greater non-motor symptom burden is associated with thalamic atrophy in PD. Thalamus plays an important role in processing sensory information including visceral afferent from the gastrointestinal tract and in regulating states of sleep and wakefulness.

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Predictors of Global Non-Motor Symptoms Burden Progression in Parkinson’s Disease. Results from the COPPADIS Cohort at 2-Year Follow-Up

Journal of Personalized Medicine ◽

10.3390/jpm11070626 ◽

2021 ◽

Vol 11 (7) ◽

pp. 626

Author(s):

Diego Santos-García ◽

Teresa de Deus ◽

Carlos Cores ◽

Hector Canfield ◽

Jose Paz González ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Problems ◽

Neuropsychiatric Symptoms ◽

Control Group ◽

Motor Symptoms ◽

Linear Regression Models ◽

Watson Test ◽

Non Motor Symptoms

Background and Objective: Non-motor symptoms (NMS) progress in different ways between Parkinson’s disease (PD) patients. The aim of the present study was to (1) analyze the change in global NMS burden in a PD cohort after a 2-year follow-up, (2) to compare the changes with a control group, and (3) to identify predictors of global NMS burden progression in the PD group. Material and Methods: PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017, were followed-up with after 2 years. The Non-Motor Symptoms Scale (NMSS) was administered at baseline (V0) and at 24 months ± 1 month (V2). Linear regression models were used for determining predictive factors of global NMS burden progression (NMSS total score change from V0 to V2 as dependent variable). Results: After the 2-year follow-up, the mean NMS burden (NMSS total score) significantly increased in PD patients by 18.8% (from 45.08 ± 37.62 to 53.55 ± 42.28; p < 0.0001; N = 501; 60.2% males, mean age 62.59 ± 8.91) compared to no change observed in controls (from 14.74 ± 18.72 to 14.65 ± 21.82; p = 0.428; N = 122; 49.5% males, mean age 60.99 ± 8.32) (p < 0.0001). NMSS total score at baseline (β = −0.52), change from V0 to V2 in PDSS (Parkinson’s Disease Sleep Scale) (β = −0.34), and change from V0 to V2 in NPI (Neuropsychiatric Inventory) (β = 0.25) provided the highest contributions to the model (adjusted R-squared 0.41; Durbin-Watson test = 1.865). Conclusions: Global NMS burden demonstrates short-term progression in PD patients but not in controls and identifies worsening sleep problems and neuropsychiatric symptoms as significant independent predictors of this NMS progression.

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