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Real-World Nonmotor Changes in Patients with Parkinson's Disease and Motor Fluctuations: J-FIRST.

ABSTRACT: Background:Nonmotor symptoms (NMSs) of Parkinson's disease (PD) impair health-related quality of life. Objectives:To identify changes in NMSs during 52?weeks in Japanese PD patients exhibiting motor fluctuations. Methods:In PD patients with ?1 NMS and wearing-off, changes in total/subscore of the Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS) Part I and 8-item PD Questionnaire were assessed. Group-based trajectory models were used to characterize longitudinal patterns of MDS-UPDRS Part I. Results:Data from 996 patients were analyzed. MDS-UPDRS Part I subscores for cognitive function decreased linearly over time. Total and subscores for apathy and lightheadedness on standing significantly deteriorated with fluctuations, whereas other subscores fluctuated without significant deterioration. Changes in the MDS-UPDRS Part I total score correlated with changes in the 8-item PD Questionnaire total score. Based on group-based trajectory models, longitudinal pattern analysis of MDS-UPDRS Part I scores yielded the following 3 separate groups: unchanged (63.8%), deteriorated (20.1%), and improved (16.2%). The improved group had significantly more NMSs at baseline, significantly higher MDS-UPDRS Part I/8-item PD Questionnaire total scores, and modified Hoehn and Yahr scores, and had received treatment for NMSs. The multivariate analysis revealed significant associations between severe motor disability and receiving any treatment for NMSs at baseline and improvement of MDS-UPDRS Part I total scores. Conclusions:Changes in MDS-UPDRS Part I scores were variable and related to changes in health-related quality of life in PD patients with motor fluctuations.

SUBMITTER: Watanabe H

PROVIDER: S-EPMC7197319 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Real-World Nonmotor Changes in Patients with Parkinson's Disease and Motor Fluctuations: J-FIRST.

Watanabe Hirohisa H Saiki Hidemoto H Chiu Shih-Wei SW Yamaguchi Takuhiro T Kashihara Kenichi K Tsuboi Yoshio Y Nomoto Masahiro M Hattori Nobutaka N Maeda Tetsuya T Shimo Yasushi Y

Movement disorders clinical practice 20200411 4

<h4>Background</h4>Nonmotor symptoms (NMSs) of Parkinson's disease (PD) impair health-related quality of life.<h4>Objectives</h4>To identify changes in NMSs during 52 weeks in Japanese PD patients exhibiting motor fluctuations.<h4>Methods</h4>In PD patients with ≥1 NMS and wearing-off, changes in total/subscore of the Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS) Part I and 8-item PD Questionnaire were assessed. Group-based trajectory models were used to characterize longitudinal ...[more]

PMID: 32373660

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Project description:Lewy body diseases, such as Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA), are associated with a wide range of nonmotor symptoms (NMS), including cognitive impairment, depression and anxiety, sleep disorders, gastrointestinal symptoms, and autonomic failure. The reason why such diverse and disabling NMS have not been weeded out but have persisted across evolution is unknown. As such, one possibility would be that the NMS might be somehow beneficial during development and/or reproductive stages, a possibility consistent with our recent view as to the evolvability of amyloidogenic proteins (APs) such as ?-synuclein (?S) and amyloid-? (A?) in the brain. Based on the heterogeneity of protofibrillar AP forms in terms of structure and cytotoxicity, we recently proposed that APs might act as vehicles to deliver information regarding diverse internal and environmental stressors. Also, we defined evolvability to be an epigenetic phenomenon whereby APs are transgenerationally transmitted from parents to offspring to cope with future brain stressors in the offspring, likely benefitting the offspring. In this context, the main objective is to discuss whether NMS might be relevant to evolvability. According to this view, information regarding NMS may be transgenerationally transmitted by heterogeneous APs to offspring, preventing or attenuating the stresses related to such symptoms. On the other hand, NMS associated with Lewy body pathology might manifest through an aging-associated antagonistic pleiotropy mechanism. Given that NMS are not only specific to Lewy body diseases but also displayed in other disorders, including amyotrophic lateral sclerosis (ALS) and Huntington's disease (HD), these conditions might share common mechanisms related to evolvability. This might give insight into novel therapy strategies based on antagonistic pleiotropy rather than on individual NMS from which to develop disease-modifying therapies.

Dataset Information

Real-World Nonmotor Changes in Patients with Parkinson's Disease and Motor Fluctuations: J-FIRST.

Publications

Real-World Nonmotor Changes in Patients with Parkinson's Disease and Motor Fluctuations: J-FIRST.

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