Objective: To analyze the prevalence and severity of non-motor symptoms (NMS) in Parkinson disease (PD) motor subtypes (tremor-dominant, TD; postural instability/gait disorder, PIGD; and indeterminate), using the new Movement Disorders Society-NMS scale (MDS-NMS).

Background: PD motor subtypes are characterized by motor features and by differences in prevalence and severity of NMS. The new MDS-NMS, which includes a higher variety of NMS than its predecessor, the NMSS, might allow better differentiation of NMS symptoms and profiles across PD subtypes.

Method: Multi-center, international (USA and UK), cross-sectional study, with a sample of 402 PD patients, recruited in the context of the MDS-NMS validation study. Patients were administered the MDS-NMS, HY staging, MDS-Unified PD Rating Scale (MDS-UPDRS), and the NMSS. Motor subtypes were identified using the MDS-UPDRS (Stebbins et al. Mov Disord 2013;28:668-70). Differences in frequency (scores ≥1, possible score 0-16 per item) and severity (means and SD) of MDS-NMS individual items (N=52) by motor subtype were computed, using chi-square, Mann-Whitney and Kruskal-Wallis tests. Spearman’s rank correlation coefficients of MDS-NMS total score by subtypes with other assessments and variables were calculated.

Results: The sample (62.2% men) had mean age of 67.42 years old (SD: 9.96) and, PD duration of 8.2 years (SD: 5.93), and was mainly in HY stage 2 (54.5%). MDS-UPDRS part 3 mean score was 29.45 (SD: 13.73). Regarding subtypes, 235 (58.5%) were TD, 141 (35.1%) PIGD and 26 (6.5%) Indeterminate. PIGD patients showed higher scores in MDS-NMS domains of Anxiety, Urinary, Gastrointestinal, Sleep & wakefulness, Other, and Non-motor fluctuations (p<0.05) than TD patients. Muscle/joint/back pain was the most common NMS in the three subtypes. Prevalence of specific symptoms of hallucinations, difficulties with attention and finding words, nocturia, insomnia, and musculoskeletal pain was higher in PIGD than in the other subtypes (p<0.02). Correlation coefficients of MDS-NMS total score with NMSS ranged from 0.80 (indeterminate) to 0.89 (TD), and correlation with MDS-UPDRS Part I were from 0.59 (indeterminate) to 0.76 (PIGD) (differences non-significant).

Conclusion: PD patients with PIGD have higher prevalence and severity of multiple NMS compared with TD or indeterminate patients. This results could inform the clinical management and treatment of PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-symptoms-in-parkinson-disease-motor-subtypes-a-study-using-the-new-mds-nms/