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      Change in Non-motor Symptoms in Parkinson's Disease and Essential Tremor Patients: A One-year Follow-up Study

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          Abstract

          Background

          Non-motor symptoms (NMS) in Parkinson's disease (PD) differ from those in essential tremor (ET), even before a definitive diagnosis is made. It is not clear whether patient's knowledge of the diagnosis and treatment influence their subsequent reporting of NMS.

          Methods

          1 year after a clinical and instrumental diagnosis, we compared the motor impairment (Movement Disorders Society (MDS) -Unified Parkinson's Disease Rating Scale-III) and non-motor symptoms (NMSQuest) in PD (n = 31) and ET (n = 21) patients.

          Results

          PD patients reported more NMS than did the ET patients (p = 0.002). When compared to their baseline report, at follow-up, PD patients reported less nocturia (p = 0.02), sadness (p = 0.01), insomnia (p = 0.02), and restless legs (p = 0.04) and more nausea (p = 0.024), unexplained pain (p = 0.03), weight change (p = 0.009), and daytime sleepiness (p = 0.03). When compared to their baseline report, ET patients reported less loss of interest (p = 0.03), anxiety (p = 0.006), and insomnia (p = 0.02). Differences in reported weight change (p<0.0001) and anxiety (p = 0.001) between PD and ET patients were related to pharmacological side effects or to a reduction in the ET individuals.

          Discussion

          The reporting of NMS is influenced by subjective factors, and might vary with the patient's knowledge of the diagnosis or the effectiveness of treatment.

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          Most cited references12

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          Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee.

          G. Deuschl, P Bain, M Brin (1998)
          This is a proposal of the Movement Disorder Society for a clinical classification of tremors. The classification is based on the distinction between rest, postural, simple kinetic, and intention tremor (tremor during target-directed movements). Additional data from a medical history and the results of a neurologic examination can be combined into one of the following clinical syndromes defined in this statement: enhanced physiologic tremor, classical essential tremor (ET), primary orthostatic tremor, task- and position-specific tremors, dystonic tremor, tremor in Parkinson's disease (PD), cerebellar tremor, Holmes' tremor, palatal tremor, drug-induced and toxic tremor, tremor in peripheral neuropathies, or psychogenic tremor. Conditions such as asterixis, epilepsia partialis continua, clonus, and rhythmic myoclonus can be misinterpreted as tremor. The features distinguishing these conditions from tremor are described. Controversial issues are outlined in a comment section for each item and thus reflect the open questions that at present cannot be answered on a scientific basis. We hope that this statement provides a basis for better communication among clinicians working in the field and stimulates tremor research.
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            Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder.

            S Bundlie, M Mahowald, R C Schenck (1996)
            We report longitudinal data on a group of 29 male patients 50 years of age or older who were initially diagnosed as having idiopathic REM sleep behavior disorder (RBD) after extensive polysomnographic and neurologic evaluations. Thirty-eight percent (11/29) were eventually diagnosed as having a parkinsonian disorder (presumably Parkinson's disease) at a mean interval of 3.7 +/- 1.4 (SD) years after the diagnosis of RBD+, and at a mean interval of 12.7 +/- 7.3 years after the onset of RBD. To date, only 7% (2/29) of patients have developed any other neurologic disorder. At the time of RBD diagnosis, data from the RBD group with eventual Parkinson's disease (n = 11) and the current idiopathic RBD group (n = 16) were indistinguishable, with two exceptions: the RBD-Parkinson's disease group had a significantly elevated hourly index of periodic limb movements of non-REM sleep and an elevated REM sleep percentage. RBD was fully or substantially controlled with nightly clonazepam treatment in 89% (24/27) of patients in both groups. Thus, RBD can be the heralding manifestation of Parkinson's disease in a substantial subgroup of older male RBD patients. However, a number of presumed Parkinson's disease patients may eventually be diagnosed with multiple system atrophy (striatonigral degeneration subtype). Our findings indicate the importance of serial neurologic evaluations after RBD is diagnosed and implicate the pedunculopontine nucleus as a likely site of pathology in combined RBD-Parkinson's disease, based on experimental and theoretical considerations rather than on autopsy data.
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              Population-based case-control study of cognitive function in essential tremor.

              Julián Benito-León, Elan Louis, Felix Bermejo-Pareja (2006)
              To determine whether patients with essential tremor (ET) have cognitive deficits when compared with controls and whether the types of cognitive deficits reported previously are also found in this large sampling of patients with ET. A total of 232 patients with ET and 696 matched controls age 65 years or older (median 75 years) living in central Spain (the Neurologic Diseases in Central Spain study) underwent a neuropsychological assessment, including tests of global cognitive performance, frontal executive function, verbal fluency, and memory. Subjects also were asked whether they had forgetfulness. Fifty-six patients with ET were previously undiagnosed; only 14 (6%) were taking medication for tremor. Adjusted for age, gender, education, premorbid intelligence, medications, and depressive symptoms, cases performed less well on most neuropsychological tests and especially tests of global cognitive performance (37-item Mini-Mental State Examination = 27.0 +/- 6.7 in cases vs 28.9 +/- 5.9 in controls, p < 0.001) and frontal executive function (Trail Making Test number of errors = 8.7 +/- 11.0 in cases vs 3.8 +/- 7.6 in controls, p < 0.001). Forgetfulness was reported in 117 (50.4%) patients with ET vs 300 (43.1%) controls (p = 0.05). In a population-based sample of largely untreated patients with essential tremor, cases performed more poorly on formal neuropsychological testing than did their counterparts without tremor. A complaint of forgetfulness was also marginally more common in patients with essential tremor.
              Article 0 comments Cited 53 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Tremor Other Hyperkinet Mov (N Y)
                Journal ID (iso-abbrev): Tremor Other Hyperkinet Mov (N Y)
                Journal ID (publisher-id): TOHM
                Title: Tremor and Other Hyperkinetic Movements
                Publisher: Columbia University Libraries/Information Services
                ISSN (Electronic): 2160-8288
                Publication date Collection: 2014
                Publication date (Electronic): 14 April 2014
                Volume: 4
                Electronic Location Identifier: 216
                Affiliations
                [1 ]Operative Unit of Neurology, “Dimiccoli” General Hospital, Barletta, Italy
                [2 ]Operative Unit of Nuclear Medicine, “Dimiccoli” General Hospital, Barletta, Italy
                Columbia University, United States of America
                Author notes
                *To whom correspondence should be addressed. E-mail: mauriziogiorelli@ 123456alice.it
                Article
                DOI: 10.7916/D82J68TH
                PMC ID: 3986491
                PubMed ID: 24757583
                SO-VID: 22b63ed9-de87-41e9-a7b0-d1d8991e5d78
                Copyright statement: Copyright @ 2014
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution–Noncommerical–No Derivatives License, which permits the user to copy, distribute, and transmit the work provided that the original author and source are credited; that no commercial use is made of the work; and that the work is not altered or transformed.

                History
                Date received : 14 December 2013
                Date accepted : 24 January 2014
                Page count
                Pages: X
                Categories
                Subject: Brief Reports

                Keywords: non-motor symptoms,nmsquest,parkinson's disease,essential tremor,follow-up
                Data availability:
                Keywords: non-motor symptoms, nmsquest, parkinson's disease, essential tremor, follow-up

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