Objective: To examine the timing of emergence of non-motor fluctuations (NMF) with reference to motor fluctuations (MF) in Parkinson’s Disease (PD).

Background: NMF and MF are very frequent in patients with Parkinson’s disease (PD) receiving long-term medical treatment. Their incidence and timing have not been examined in a prospective study.

Methods: A total of 334 patients with PD who had neither MF nor NMF were recruited. The “SNUH-Fluctuation Questionnaire” consisting of 29 items (9 on MF and 20 on NMF) was administered every 6 month in the outpatient clinic for 3 years. Age, gender, age at PD onset, disease duration, total levodopa equivalent daily dose, and Hoehn & Yahr stage at baseline were collected.A total of 334 patients with PD who had neither MF nor NMF were recruited. The “SNUH-Fluctuation Questionnaire” consisting of 29 items (9 on MF and 20 on NMF) was administered every 6 month in the outpatient clinic for 3 years. Age, gender, age at PD onset, disease duration, total levodopa equivalent daily dose, and Hoehn & Yahr stage at baseline were collected.

Results: 60 patients were excluded from the study (9 with alternative diagnosis during follow-up, 41 with poor Mini Mental Status Examination scores (MMSE<26), 3 with comorbidity such as cancer or epilepsy, and 7 who withdrew consent. 274 out of 334 patients were eligible for Kaplan-Meire survival analysis of symptom fluctuations. MF were more frequent and developed earlier than NMF (cumulative survival of 0.527 for MF and 0.597 for NMF at 36 months follow-up). [Figure 1]

183 patients (90 males and 93 females) were included for subgroup analysis according to the timing of development of fluctuations. MF and NMF developed simultaneously in 47 (25.8%), MF first in 42 (23.1%), and NMF first in only 3 (1.7%). 91 (50%) did not develop either MF or NMF. The age of onset and age at enrollment tended to be younger in the fluctuators. The most frequent MF and NMF manifestation was bradykinesia and fatigue respectively both at the onset of fluctuations and during the entire follow-up period. [Table 1]

Conclusions: NMF usually develop later than MF in PD, but can develop earlier than MF in a small number of patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/emergence-of-non-motor-fluctuations-with-reference-to-motor-fluctuations-in-parkinsons-disease/