Objective: To investigate the impact of non-motor fluctuations for QOL in patients with Parkinson’s disease (PwPD) using a nine-item wearing-off questionnaire (WOQ-9).

Background: Long-term levodopa treatment in PwPD often causes motor fluctuations, which are known to affect their quality of life (QOL). These motor fluctuations may be accompanied by fluctuations in non-motor symptoms. There is no consensus on how non-motor fluctuations affect QOL.

Method: This was a single-center, retrospective study and included consecutive 375 PwPD who visited the neurology department of Fukuoka University Hospital between July 2015 and June 2018. All patients were evaluated for age, sex, disease duration,　and motor symptoms by the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale part III, depression scale by the Zung self-rating depression scale, and cognitive function by the Japanese version of The Montreal Cognitive Assessment. WOQ-9 was used to assess the motor and non-motor fluctuations. QOL in PwPD was investigated using the 8-item Parkinson’s Disease Questionnaire (PDQ-8). We performed the analysis using analysis of covariance (ANCOVA) with Tukey’s post-hoc test after adjusting for covariates. We compared with the item of the non-motor fluctuation among each of motor subtypes of the patients and analyzed the relationship between them by chi-square test. All analyses were conducted using IBM SPSS v.26 and SAS software v.9.4.

Results:  In total, 375 PwPD were enrolled and classified into three groups according to the presence or absence of motor and non-motor fluctuations. Among them, the PDQ-8 SUM and SI were significantly higher in PWPD with non-motor fluctuations (NFL group) than in the other groups (p<0.005). Furthermore, multivariable analysis showed that even one non-motor fluctuation was an independent factor that worsened QOL (p<0.001). There were linear associations between the scores of PDQ-8 SUM/ PDQ-8 SI and the numbers of motor and/or non-motor fluctuations (p<0.005). The proportion of PwPD with motor and non-motor fluctuations increased when the PD disease duration increased (p<0.05).

Conclusion: This study showed that PwPD with non-motor fluctuation had a lower QOL than those with no or only motor fluctuation. Moreover, the data showed that PDQ-8 scores were significantly reduced even with only one non-motor fluctuation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-non-motor-fluctuations-on-qol-in-patients-with-parkinsons-disease/