Non-motor symptoms in Thai Parkinson ’ s disease patients and the correlation with motor symptoms

Background and objective:to identify the prevalence of non-motor symptoms (NMS) and to determine the association between NMS and motor symptoms in Thai Parkinson’s disease (PD) patients. Methods: A cross sectional study was performed in PD patients at Maharat Nakhon Ratchasima Hospital between January-June 2014. The NMS were assessed by using Non-Motor Symptoms Questionnaire-Thai version. All data were analyzedfor identifying the prevalence of NMS and determining the correlation between NMS and motor symptoms. Results:One hundred thirty six PD patients were enrolled. The severity of disease according to Modified Hoehn and Yahr (MHY) was 1-1.5=33.1% of the patients, 2-2.5=52.2% and 3-5=14.7%. All patients (100%) had NMS with mean number of 13.2±6.7 symptoms (ranging from 1-29). Nocturia was the commonest symptom (82.4%), followed by constipation (74.3%) and forgetfulness (69.9%). Bowel incontinence was the least frequent symptom (19.9%). Sleep disorder was the mostprevalent domain (92.6%), followed by digestive domain (91.9%) and urinary domain (89.0%). The number of NMS significantly increased with the degree of severity of disease and was higher in patients with motor complications. Conclusion:NMS were reported by every Thai PD patients, and at all stage of the disease. Nocturia symptom and sleep disorder domain were the most frequent NMS. The number of NMS strongly correlated with motor complications and the severity of motor symptoms. However the presence of motor complications appears to have stronger association with some NMS domains than the motor severity. Neurology Asia 2016; 21(1) : 41 – 46 Address correspondence to: Pawut Mekawichai MD, Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima Province, 30000 Thailand. Tel +66-81-878-5168, Email: emcsquares@gmail.com INTRODUCTION Parkinson’s disease (PD) is a complex neurodegenerative disease with high clinical heterogeneity. The clinical features of PD are combination of motor symptoms (tremor, rigidity, bradykinesia and postural instability) and nonmotor symptoms (NMS) such as neuropsychiatric problems, sensory symptoms, sleep disorders and autonomic dysfunctions. There is now increasing evidences that NMS in PD are common, occur in any stages of disease, associate with poor quality of life and mayhave equally or more significant disability than motor symptoms in some PD patients. Although NMS are common, they are not well recognized in clinical practice. One study in US showed some NMS were not identified by neurologistsin over 50% of cases. From this reason, the American Academy of Neurology in 2007 has developed the questionnaires for physicians detecting NMS in PD. In Thailand, the prevalence of PD patients is 0.24% of population (about 170,000 Thai citizens) whereas the prevalence of NMS is about 97-100% of PD patients. The aim of this study was to identify the prevalence of NMS and the relationship of this condition with motor symptoms in Thai PD patients at Maharat Nakhon Ratchasima Hospital (MNRH), the tertiary care hospital in northeastern region of Thailand.