Objective: To evaluate the frequency of non motor fluctuations (NMF) in Parkinson’s disease (PD), their correlation with motor complications and their impact on the quality of life in a Tunisian cohort.

Background: Non motor symptoms (NMS) can fluctuate either along or irrespective to motor on/off phenomena. Though under-estimated for a long time and poorly studied, NMF could appear earlier and be more troublesome than motor fluctuations (MF).

Method: We conducted a cross-sectional study in the Department of Neurology at Razi University Hospital in Tunisia (September 2017-February 2019) including patients with PD taking levodopa for at least 3 months. Demographic, clinical and therapeutic data were collected. We used the NMS Assessment scale for PD (NMSS) to evaluate NMS, the NoMoFA questionnaire to identify NMF, the Unified PD Rating scale (UPDRS) parts III and IV for motor symptoms and MF and the PD Questionnaire-8 (PDQ-8) to evaluate the Health-related quality of life (HRQOL).

Results: One hundred and ten patients were included (sex-ratio=1,2; mean age of 64,78 years [33-89], mean age at onset of PD of 56,62 years [30-80] and mean disease duration of 8,59 years). NMS were present in all patients. The most frequent and severely affected areas were mood and cognition followed by sleep and fatigue. The frequencies of MF and NMF were respectively 87,3% and 81,13%. Seventy-nine patients (73,14%) had simultaneously MF and NMF, and 9,25% of patients with NMF did not have MF. There was no correlation between the presence of NMF and MF (p=0,08). Almost 82,1% of patients with NMF had more than one type of NMF. Daily doses of levodopa were correlated with MF (p=0.024) but not with NMF (p=0,106). There was no statistically significant difference between patients with NMF and those without NMF in terms of gender, age at onset, disease duration and NMSS. The presence of NMF was associated with worse HRQOL (p=0.022) unlike the presence of MF (p=0,809). PDQ-8 index was higher in patients with fluctuations of pain, low energy and anxiety.

Conclusion: In our cohort, NMF were common, independent from MF and doses of levodopa, with higher negative impact on HRQOL than MF. Their recognition is required to adjust their management and improve the quality of life of patients with PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-fluctuations-in-parkinsons-disease-findings-from-a-tunisian-cohort/