Distribution of Non-Motor Symptoms in Idiopathic Parkinson's Disease and Secondary Parkinsonism
Condition: Parkinson Disease
MeSH terms: Parkinson Disease; Parkinsonian Disorders; Parkinson Disease, Secondary
Study type: Observational

Summary: 
      BACKGROUND:

      Non-Motor Symptoms (NMS) are frequent in patients with Idiopathic Parkinson's Disease (IPD).
      Clinical expressions, postulated pathophysiological mechanisms and responsiveness to
      antiparkinson medication represent differences between IPD and secondary Parkinsonism (SP).

      OBJECTIVES:

      To evaluate NMS expressions in IPD, SP and a control group.

      METHODS:

      Diagnosis of SP was supported by comorbidity, radiological findings, type of onset, onset
      rate and progression, exposures for neuroleptics, and responsiveness to pharmacological
      antiparkinson therapy.

      The participants were consecutively recruited at two outdoor patient clinics. The Well-Being
      Map™ for evaluation. These were completed by the participants at one point before visit. The
      controls consisted of non-Parkinsonian individuals, matched by age and gender.
    

Detailed description: 
      Over the past decades knowledge of the natural history and progression of Parkinson´s disease
      (PD) has increased. Age at onset, time to troublesome complications are well described.
      Parallell to this, the society has been more and more aware of differences between gender in
      the expressions of diseases. Differences in self reported experiences are of great interest
      as this is tightly interconnected with Health Related Quality of Life, (HRQoL).

      The incidence of PD rapidly increase over the age of 60 years (y) , with only 4% of the cases
      being under the age of 50 y. The rate for men 19.0 per 100,000, was 91% higher than that for
      women (9.9 per 100,000 )The age- and gender-adjusted rate per 100,000 was highest among
      Hispanics (16.6,non-Hispanic Whites ,Asians (11.3, and Blacks (10.2). These data suggest that
      the incidence of Parkinson's disease varies by race/ethnicity.

      ( ref. Van den Eeden 2003)

      Nonmotor Symptoms in Parkinson's Disease:

      Of the nine domains in the validated NMSS (Chaudhuri, Martinez- Martin, Brown, et al., 2007),
      sexual dysfunction and mood changes have been commonly observed to have associations with
      specific gender. While sexual dysfunction has been commonly reported with a significantly
      higher proportion among men (Kova ́cs, Makkos, Aschermann, et al., 2016; Martinez-Martin,
      Falup Pecurariu, Odin, et al., 2012; Picillo, Amboni, Erro, et al., 2013; Solla, Cannas,
      Ibba, et al., 2012; Szewczyk- Krolikowski, Tomlinson, Nithi, et al., 2014), mood symptoms,
      which encompass loss of interest in surroundings, lack of motivation, feeling ner- vous, flat
      mood, and difficulty in experiencing pleasure, have been frequently reported among women in a
      higher proportion compared to men with PD (Guo, Song, Chen, et al., 2013; Martinez-Martin et
      al., 2012; Nicoletti, Vasta, Mostile, et al., 2017; Solla et al., 2012; Song, Gu, An, & Chan,
      2014).

      It is well known that in the general population ( not specific parkinsonism ) in
      industrialized societies men die earlier than women but that women have poorer health than
      men. Differences discussed are differences in biological risks and acquired risks . But
      studies have revealed that the variations in health experiences depend on the particular
      symptom or condition in question and also according to the phase of the life cycle.

      Already In an article by S.Macintyre et al from 1996 two large British surveys were examined
      and revealed a larger complexity than earlier studies had shown in the description of health
      surveys and differences between gender. These often described the consistency of reporting
      more illness , poorer self-evaluation of health and higher rates of psychosocial malaise in
      women than in men.

      In this study more complex patterns of sex differences were shown for different symptoms
      reported. 'Worrying', 'nerves', 'always tired', 'headaches', 'constipation' and 'fainting or
      dizziness' showed the most consistent female excess. Sickness, nausea or stomach trouble were
      only dominating among 18 year old females and 'trouble with eyes' among 56-60 year olds in
      another large survey. In contrast, two symptoms, 'palpitations' and 'trouble with ears' show
      a male excess among middle aged. Female excess was only consistently found across the life
      span for the more psychological manifestations of distress, and was far less apparent for a
      number of physical symptoms and conditions.

      Problems relating to reproduction will naturally show a female excess in the childbearing
      years, hormonal differences are apparent before and after the menopause.

      Probably an oversimplification have been the fact in older sociological and epidemiological
      literature and over-generelization has become the norm.

      There is a widely accepted belief that women use health services, particularly mental health
      services, more than men. Haavio-Manila has, however, reported that while women had higher
      psychiatric admission rates than men in Norway, in Finland and Sweden men had higher rates
      (Haavio-Manila E. Inequalities in health and gender. Soc. Sci. Med. 22, 141, 1986.) Why are
      more recent data more complex to understand than older studies in the field of gender
      differences? One possibility is that female/male differences in health have changed over time
      (in the same way that male/female differences in life expectancy may have changed over time
      (Macintyre S. Gender differences in longevity and health in Eastern and Western Europe. In
      Locating Health: Sociological and Historial Explanations (Edited by Platt S., Thomas H.,
      Scott S. and Williams G.), pp. 57-74. Avebury, Aldershot, 1993.

      If we are to make progress towards understanding to whether social, psychological or
      biological produce or maintain gender differences in health, it is important to pay attention
      to the social and historical context of the observations, and to take a more differentiated
      agespecific and condition-specific view of 'health' when examining differences between the
      sexes.

      (Wingard D. L., Cohn B. A., Kaplan G. A., Cirillo P. M. and Cohen R. D. Sex differentials in
      morbidity and mortality risks examined by age and cause in the same cohort. Am. J. Epidemiol.
      130, 601, 1989. )

      National Quality Registers

      A National Quality Registry contains individualised data concerning patient problems, medical
      interventions, and outcomes after treatment; within all healthcare production. It is annually
      monitored and approved for financial support by an Executive Committee.

      Swedish Neuro Registries is a quality register with the aim of ensuring that neurological
      care is equitable and of high quality and to ensure treatment guidelines are being followed.

      Swedish Neuro Registries are represented in all counties and all hospitals where neurological
      care is provided. It will be the base for national neurological research.

      The registry started as an MS registry in 1996. In 2012, it became Swedish Neuro Registries
      with 8 diagnosis: Multiple Sclerosis, Parkinson's Disease, Myasthenia Gravis , Narcolepsy,
      Epilepsy, Motor Neuron Disease, Inflammatory Polyneuropathy and Severe Neurovascular
      Headache. REFERENS:(
      http://kvalitetsregister.se/englishpages/findaregistry/registerarkivenglish/nationalqualityre
      gistryforneurologicalcareneuroregpreviouslyswedishmsregistry.2283.html Today abou 5800
      patients are registered within the PD registry, of which about 4600 with a diagnose of PD or
      related disorders such as parkinsonism, atypical PD etcetera.
    

Intervention name(s): inquiries
Intervention type(s): Other
Intervention description(s): Inquires reported to clinician.
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Participants diagnosed with IPD or SP were recruited from routine care visits at outpatient
        departments at two medium-sized county hospitals in southern Sweden.