Non-motor clinical manifestations of Parkinson’s disease and its relevance in early diagnosis

Introduction: Parkinson’s disease is a progressive neurodegenerative disease that affects millions of people worldwide. Although Parkinson’s disease has traditionally been described as a disorder of the motor system, it is now recognized as a complex disease with several clinical features that include neuropsychiatric and non-motor manifestations. Studies show that 97% of patients with Parkinson’s disease report non-motor symptoms, in addition to motor symptoms, and some non-motor characteristics may appear before classic motor signs. Objectives: To list the main non-motor clinical manifestations of Parkinson’s disease and analyze its importance in establishing an accurate and early clinical diagnosis. Methods: This is an integrative review, carried out based on the search of scientific publications indexed in the datebase MEDLINE via PubMed, Lilacs and SciELO. At the end of the searches, 66 publications met the eligibility criteria and were selected to compose the study. Results: Within the non-motor clinical manifestations, there may be present: cognitive dysfunction and dementia, psychosis and hallucinations, mood disorders, sleep disorders, fatigue, autonomic dysfunction, olfactory dysfunction, gastrointestinal dysfunction, pain, sensory disorders and dermatological manifestations. Of these, olfactory dysfunction, constipation, depression and sleep disorders stand out because they often precede the motor symptoms of Parkinson’s disease. Conclusion: In this perspective, it is up to the general practitioner and the neurologist or geriatrician to carry out, whenever possible, screening tests to identify early changes that may precede Parkinson’s disease, guaranteeing patients an early multiprofessional treatment and consequently a better prognosis in the course of the disease.

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Prevalence of sleep disorders in Parkinson’s disease patients in Ethiopia

10.21203/rs.2.442/v2 ◽

2019 ◽

Author(s):

Dereje Melka ◽

Abenet Tafesse ◽

James H. Bower ◽

Demeke Assefa

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Disorders ◽

Addis Ababa ◽

Demographic Data ◽

Previous History ◽

Sub Saharan Africa ◽

Poor Sleep ◽

Motor Symptoms ◽

Cross Sectional

Abstract Background: Non motor symptoms (NMS) of Parkinson’s disease (PD) are common and can be more disabling than motor symptoms.Sleep disorders can be seen in up to 98% of patients with Parkinson disease. Poor sleep quality has been associated with poverty and race, and yet there has been no prior report on sleep disorders in those with PD living in sub Saharan Africa. We wished to document the prevalence of sleep disorders in PD patients in Ethiopia. Methods: We conducted a cross-sectional point prevalence study from July 1 to October 30, 2015 of all patients attending the neurology outpatient department in Tikur Anbessa and Zewuditu Memorial Hospitals, Addis Ababa, Ethiopia. Demographic data, clinical history and physical examination findings were collected from participants using a structured questionnaire. We used the Parkinson’s disease sleep scale version two (PDSS-2) and Epworth Sleepiness Scale (ESS) to assess the sleep symptoms. Results: Of the 155 patients surveyed, all patients reported some sleep problem. Over 43.9% of patients had a PDSS score > 18. Presence of previous history of sleep disturbance before PD motor symptoms (OR 3.54; 95% CI 1.61-7.76, p=0.001) and unemployment (OR 2.27; 95% CI 1.07-4.79, p=0.023) associated with a high PDSS-2 score. The median score of ESS was 9 (IQR = 5-12), with 77/155 (49.7%) of the patients having possible or definite excessive daytime somnolence. Conclusions: In Ethiopian PD patients, the prevalence of those with severe sleep disorders is the highest reported to date. The prevalence of possible/definite EDS is amongst the highest in the world. Further investigation into whether poverty or race explains this finding is needed.

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A clinical-anatomical signature of Parkinson’s Disease identified with partial least squares and magnetic resonance imaging

10.1101/168989 ◽

2017 ◽

Cited By ~ 3

Author(s):

Yashar Zeighami ◽

Seyed-Mohammad Fereshtehnejad ◽

Mahsa Dadar ◽

D. Louis Collins ◽

Ronald B. Postuma ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Least Squares ◽

Partial Least Squares ◽

Large Scale ◽

De Novo ◽

Neurodegenerative Disorder ◽

Clinical Manifestations ◽

Motor Symptoms ◽

Non Motor Symptoms

AbstractParkinson’s disease (PD) is a neurodegenerative disorder characterized by a wide array of motor and non-motor symptoms. It remains unclear whether neurodegeneration in discrete loci gives rise to discrete symptoms, or whether network-wide atrophy gives rise to the unique behavioural and clinical profile associated with PD. Here we apply a data-driven strategy to isolate large-scale, multivariate associations between distributed atrophy patterns and clinical phenotypes in PD. In a sample of N = 229 de novo PD patients, we estimate disease-related atrophy using deformation based morphometry (DBM) of T1 weighted MR images. Using partial least squares (PLS), we identify a network of subcortical and cortical regions whose collective atrophy is associated with a clinical phenotype encompassing motor and non-motor features. Despite the relatively early stage of the disease in the sample, the atrophy pattern encompassed lower brainstem, substantia nigra, basal ganglia and cortical areas, consistent with the Braak hypothesis. In addition, individual variation in this putative atrophy network predicted longitudinal clinical progression in both motor and non-motor symptoms. Altogether, these results demonstrate a pleiotropic mapping between neurodegeneration and the clinical manifestations of PD, and that this mapping can be detected even in de novo patients.

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Nocturnal Sleep Problems Mediate the Impact on Quality of Life of Early Morning Off in Parkinson's Disease

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.681773 ◽

2021 ◽

Vol 13 ◽

Author(s):

Yu Zhang ◽

Zi en Zhang ◽

De Shi ◽

Yi Zhao ◽

Lihong Huang ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Problems ◽

Clinical Manifestations ◽

Early Morning ◽

Motor Symptoms ◽

Nocturnal Sleep ◽

The Impact

Background: Early morning off (EMO) refers to off-states in the morning in people diagnosed with Parkinson's disease (PwPD). This study determined the clinical manifestations of EMO and the association with nocturnal sleep problems and quality of life (QOL) in Chinese PwPD.Methods: In this multicenter, observational, cross-sectional study, data concerning the clinical manifestations of EMO were collected from PwPD in Shanghai by questionnaire. The stepwise logistic regression was performed to analyze the potential risk factors, as well as whether EMO was an independent risk factor for functional dependency in daily life. The mediation analyses were conducted to evaluate whether nocturnal sleep problems might mediate the association between EMO and the QOL.Results: Among the 454 subjects evaluated, EMO occurred in 39.43% of PwPD across all disease stages. The prevalence of EMO increased as the Hoehn and Yahr stage increased and was observed in 35.60% of patients in stages 1–2.5 and 48.85% of patients in stages 3–5. EMO was associated with non-motor symptoms (NMSs). The predominant NMSs associated with EMO were nocturnal sleep problems (98.90%), mood/cognition impairment (93.90%), decreased attention/memory (91.60%), gastrointestinal symptoms (91.60%), and urinary urgency (90.50%). The QOL of PwPD with EMO was significantly reduced (P < 0.001). Moreover, nocturnal sleep problems might partially mediate this relationship (indirect effect: β = 13.458, 95% boot CI: 6.436, 22.042).Conclusion: PwPD have EMO throughout all stages of the disease. Patients with EMO have severe motor symptoms and NMSs. EMO decreases the QOL in PwPD and this relationship is partially mediated by nocturnal sleep problems. In light of these findings, it is suggested that recognition and appropriate treatment of EMO and nocturnal sleep problems could improve the management of PwPD.

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EEG features in patients with Parkinson's disease during directional perception of olfactory stimuli

Annals of Clinical and Experimental Neurology ◽

10.54101/acen.2021.4.3 ◽

2021 ◽

Vol 15 (4) ◽

pp. 27-35

Author(s):

Sergey P. Kozhevnikov ◽

Irina L. Ivanova ◽

Natalia V. Komissarova ◽

Anastasia V. Shubina ◽

Matvey A. Vlasov

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Right Hemisphere ◽

Olfactory Dysfunction ◽

Olfactory Stimulation ◽

Control Group ◽

Olfactory Perception ◽

Study Results ◽

Olfactory Stimuli ◽

The Right

Introduction. Olfactory dysfunction is considered to be an early and relatively important marker of Parkinson's disease (PD). Olfactory studies using objective neurophysiological methods may become one of the diagnostic tests to identify individuals with a high risk of developing PD. The aim of the study was to assess the spectral and topographic characteristics of bioelectrical brain activity in patients with PD during directional perception of olfactory stimuli. Materials and methods. This study included 30 patients with PD (mean age was 66.5 6.5 years). The control group consisted of 20 people without PD (mean age was 65.3 8.5 years). Lavender oil, clove oil, camphor oil and -mercaptoethanol solution (an aversive stimulus) were used for olfactory stimulation, while distilled water was used as a control test. The test subject sat with their eyes closed and inhaled the presented smell for 30 seconds, while an EEG recording was made during this time. Study results. Olfactory stimulation in patients with PD showed increased synchronicity of the 3 rhythm in the right hemisphere, as well as the rhythm in the parieto-occipital regions of both hemispheres. These changes indicate significant activation of internal (endogenous) attention, increased overall, non-specific readiness potential, as well as the involvement of the limbic-reticular complex in olfactory perception. Olfactory perception in the control group was accompanied by reduction in the 1 rhythm amplitude in the parieto-occipital regions bilaterally, which may indicate moderate activation of external (exogenous) attention and the posterior attention system responsible for simple perception processes. Conclusion. Increased 3 rhythm amplitude in the right hemisphere and increased rhythm amplitude, observed during directional olfactory perception, may indicate olfactory dysfunction and should be viewed as an additional indicator when establishing a diagnosis of Parkinsons disease.

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Montreal Cognitive Assessment scale in patients with Parkinson Disease with normal scores in the Mini-Mental State Examination

Dementia & Neuropsychologia ◽

10.1590/1980-57642018dn13-010008 ◽

2019 ◽

Vol 13 (1) ◽

pp. 78-81 ◽

Cited By ~ 2

Author(s):

Krisly Arguedas Vásquez ◽

Erick Miranda Valverde ◽

Daniel Valerio Aguilar ◽

Henri-Jacques Hernández Gabarain

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Mental State ◽

Cognitive Assessment ◽

Mini Mental State Examination ◽

Montreal Cognitive Assessment ◽

Screening Tests ◽

Study Results ◽

State Examination

ABSTRACT. Several screening tests have been used for cognitive evaluation in Parkinson’s disease (PD). Objective: To evaluate the usefulness of the Montreal Cognitive Assessment (MoCA) in patients with Parkinson’s disease and no cognitive impairment complaints. Methods: A total of 40 PD patients with no complaints of cognitive problems were included. Patients were selected using the Mini-Mental State Examination (MMSE) and the MoCA was then administered. Results: 80% of patients exhibited Mild Cognitive Impairment (MCI) according to the MoCA. Statistically significant differences in visuospatial, attention and delayed recall functions were evident between the normal and abnormal MoCA groups. Conclusion: The study results suggest that MoCA may be a good screening test in patients with PD who do not present cognitive complaints.

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Association among fatigue, sleep disorders and other clinical parameters in Parkinson’s disease

European Journal of Public Health ◽

10.1093/eurpub/ckaa040.036 ◽

2020 ◽

Vol 30 (Supplement_2) ◽

Author(s):

A Asano ◽

N Asano ◽

D Mota ◽

I Gondim ◽

F Aroxa ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Sleep Disorders ◽

Sleep Disorder ◽

Clinical Parameters ◽

Motor Symptoms ◽

Nocturnal Sleep ◽

Advanced Stages

Abstract Introduction Fatigue and sleep disorders are common in Parkinson disease (PD) patients. Fatigue is not always clinically recognized because of its subjective character manifested by feelings of extreme tiredness. These non-motor symptoms can occur from the early stages of the disease and tend to persist. Objectives To evaluate fatigue in patients with PD and the possible association with sleep disorders and other clinical parameters of the PD; and to evaluate the impact of fatigue on quality of life Methodology A cross-sectional study with 123 patients with PD was implemented. The following instruments were used: Mini Mental State Examination, the Hoehn-Yarh Scale, Beck Depression Inventory, Parkinson’s Disease Quality of Life Questionnaire, Parkinson’s Disease Sleep Scale, Epworth Sleepiness Scale, and Parkinson’s Disease Fatigue Scale. Results Fatigue was found in 48% of patients. Patients with fatigue presented longer duration of illness, depressive symptoms, cognitive impairment, severity of motor symptoms, excessive daytime sleepiness and nocturnal sleep disorder. Fatigue combined with sleep disorder occurred in 21% of the total sample, being more frequent in females (32% vs 15%) and in patients at more advanced stages of the disease (52% in HY3). The multiple logistic regression analysis indicated that the significant independent variables for the presence of fatigue were: cognition (OR = 1.19 P = 0.02), nocturnal sleep disorder (OR = 1.03 P = 0.0001); among PDSS domains, nocturnal motor symptoms (OR = 1.09 P = 0.0005) and sleep refreshment (OR = 1.11 P = 0.02); among PDQ-39 domains, mobility (OR = 0.9323 P < 0.0001) and body discomfort (OR = 0.9767 P = 0.0428). Conclusion Fatigue is common in PD, especially in the more advanced stages, and it seems to be associated with the female gender, nocturnal sleep disorder and cognition, having thus a negative impact on 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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Effects of Motor Symptom Laterality on Clinical Manifestations and Quality of Life in Parkinson’s Disease

Journal of Parkinson s Disease ◽

10.3233/jpd-202067 ◽

2020 ◽

Vol 10 (4) ◽

pp. 1611-1620 ◽

Cited By ~ 1

Author(s):

Esther Cubo ◽

Pablo Martínez-Martín ◽

Jerónimo González-Bernal ◽

Elena Casas ◽

Sandra Arnaiz ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Effect Size ◽

Clinical Manifestations ◽

Motor Symptom ◽

Life Questionnaire ◽

Motor Symptoms ◽

The Impact

Background: The asymmetry of motor manifestations present in Parkinson’s disease (PD) suggests the existence of differences between both hemispheres. As a consequence, this asymmetry might contribute to different PD clinical phenotypes. Objective: To study the relationship between motor symptom laterality with motor, non-motor symptoms (NMS), freezing of gait (FOG), and quality of life (QoL) impairment in PD. Methods: In this cross-sectional study, we measured motor symptoms severity and complications with the Unified Parkinsons’ disease Rating Scale (UPDRS), FOG with the FOG questionnaire, QoL with the 39-item PD Quality of Life Questionnaire Summary Index, and NMS with the NMS, Visual Analogue Scales for Pain and Fatigue, Beck Depression Inventory-II, Impulsive-Compulsive Disorders, and PD Sleep and Cognitive Rating scales. We defined left and right motor laterality using the UPDRS part III. We used comparative, regression, and effect size analyses to evaluate the impact of asymmetry on motor and NMS, FOG, and QoL. Results: 342 left (LPD) and 310 right (RPD) patients, with a mean age of 62.0±8.8 years, were included. In multivariate regression analysis, LPD was associated with a greater motor (OR = 1,50, 95% CI 1.02–2.21), FOG (OR = 1.56, 95% CI 1.01–2.41), and overall NMS impairment (OR = 1.43, 95% CI 1.001–2.06), and better QoL (OR = 0.52 95% CI 0.32–0.85). Overall, only a mild effect size was found for all comparisons in which significant differences were present. Conclusion: In this large multicenter study, motor symptom laterality seems to carry a mild but significant impact on PD clinical manifestations, and QoL.

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Recent advances in the pathology of prodromal non-motor symptoms olfactory deficit and depression in Parkinson’s disease: clues to early diagnosis and effective treatment

Archives of Pharmacal Research ◽

10.1007/s12272-021-01337-3 ◽

2021 ◽

Author(s):

Yeojin Bang ◽

Juhee Lim ◽

Hyun Jin Choi

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Olfactory Dysfunction ◽

Substantia Nigra Pars Compacta ◽

Motor Symptoms ◽

Olfactory Testing ◽

Increased Risk ◽

Non Motor Symptoms

AbstractParkinson’s disease (PD) is a progressive neurodegenerative disease characterized by movement dysfunction due to selective degeneration of dopaminergic neurons in the substantia nigra pars compacta. Non-motor symptoms of PD (e.g., sensory dysfunction, sleep disturbance, constipation, neuropsychiatric symptoms) precede motor symptoms, appear at all stages, and impact the quality of life, but they frequently go unrecognized and remain untreated. Even when identified, traditional dopamine replacement therapies have little effect. We discuss here the pathology of two PD-associated non-motor symptoms: olfactory dysfunction and depression. Olfactory dysfunction is one of the earliest non-motor symptoms in PD and predates the onset of motor symptoms. It is accompanied by early deposition of Lewy pathology and neurotransmitter alterations. Because of the correlation between olfactory dysfunction and an increased risk of progression to PD, olfactory testing can potentially be a specific diagnostic marker of PD in the prodromal stage. Depression is a prevalent PD-associated symptom and is often associated with reduced quality of life. Although the pathophysiology of depression in PD is unclear, studies suggest a causal relationship with abnormal neurotransmission and abnormal adult neurogenesis. Here, we summarize recent progress in the pathology of the non-motor symptoms of PD, aiming to provide better guidance for its effective management.

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Psychiatric aspects of Parkinson’s disease

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.143197 ◽

2015 ◽

Vol 6 (01) ◽

pp. 065-076 ◽

Cited By ~ 27

Author(s):

Sandeep Grover ◽

Mansi Somaiya ◽

Santhosh Kumar ◽

Ajit Avasthi

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Decline ◽

Psychiatric Disorders ◽

Sleep Disturbances ◽

Psychiatric Morbidity ◽

Clinical Manifestations ◽

Pain Syndrome ◽

Motor Symptoms ◽

Psychiatric Disturbances

ABSTRACTParkinson’s disease (PD) is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the “tip of the iceberg” of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control), sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation) and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD.

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