Objective: To identify changes in non-motor symptoms (NMSs) over time in Japanese Parkinson’s disease (PD) patients without dementia exhibiting motor fluctuations.

Background: PD can cause NMSs such as mood and sleep disorders, autonomic failure and sensory problems, which can impact QOL. We assessed changes in Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS) Part I scores over time. We also assessed the relationship between changes in MDS-UPDRS and the eight-item PD questionnaire (PDQ-8), and characteristics of changes in MDS-UPDRS and associated clinical factors.

Methods: This was a 52-week observational study conducted in 35 in Japan. PD patients with ≥1 NMS and wearing off on anti- treatment were eligible. Primary measurements were changes in total/ of the MDS-UPDRS Part I and changes in health-related QOL assessed by the PDQ-8. The mH&Y was used to measure overall motor disability.

Results: Of 1021 enrolled patients, 996 entered the observation period. MDS-UPDRS Part I subscores related to cognitive function deteriorated linearly over time. Total score and subscores for apathy and light-headedness on standing significantly deteriorated with fluctuations while other subscores fluctuated without significant deterioration. Changes in MDS-UPDRS Part I total score correlated with changes in PDQ-8 total score and were classified into three groups according to change from baseline using group-based modelling of longitudinal data: Unchanged (62.1%); Deteriorated (mean deterioration = 6.37 points at week 52, 21.3%); and Improved (mean improvement = 5.98 points at week 52, 16.5%). The Improved group had a significantly higher number of NMSs at baseline, as well as significantly higher MDS-UPDRS Part I/PDQ-8 total scores and mH&Y scores. Fluctuations were observed for sleep problems, daytime sleepiness, pain and other sensations, fatigue and items related to autonomic symptoms. In each group, levodopa-carbidopa or levodopa-benserazide use decreased over time but levodopa-carbidopa-entacapone combination drugs, rotigotine and istradefylline use increased.

Conclusions: Changes in MDS-UPDRS Part I scores are correlated with QOL changes in PD patients with motor fluctuations in real-world settings. Sleep/fatigue problems, pain, and autonomic symptoms fluctuate over time.

Note: The authors represent a study group (J-FIRST group).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/real-world-non-motor-score-changes-in-parkinsons-disease-patients-with-motor-fluctuations-the-j-first-study/