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Prevalence of Non-Motor Symptoms and Non-Motor Fluctuations in Parkinson's Disease Using the MDS-NMS

Research output: Contribution to journalArticlepeer-review

Carmen Rodriguez-Blazquez, Anette Schrag, Alexandra Rizos, K. Ray Chaudhuri, Pablo Martinez-Martin, Daniel Weintraub

Original languageEnglish
Pages (from-to)231-239
Number of pages9
JournalMovement Disorders Clinical Practice
Issue number2
PublishedFeb 2021

Bibliographical note

Funding Information: C.R.‐B. has nothing to disclose. A.S., research funding or support from University College London, National Institute of Health (NIHR), National Institute for Health Research ULCH Biomedical Research Centre, the International Parkinson and Movement Disorder Society (IPMDS), the European Commission, Parkinson's UK, GE Healthcare and the Economic and Social Research Council. Advisory board or consultancy from Biogen, Abbvie, Roche, Bial, GE Healthcare; and Royalties from Oxford University Press. A.R. has received salary support from the National institute of Health Research (NIHR) Clinical Research Network (CRN) South London, Guy's Hospital, Great Maze Pond, London UK and honorarium from Britannia Pharmaceuticals Ltd, UK. K.R.C., Advisory board: AbbVie, UCB, GKC, Bial, Cynapsus, Novartis, Lobsor, Stada, Medtronic, Zambon, Profile, Sunovion, Roche, Therevance, Scion, Britannia. Honoraria for lectures: AbbVie, Britannia, UCB, Mundipharma, Zambon, Novartis, Boeringer Ingelheim. Grants (Investigator Initiated): Britania Pharmaceuticals, AbbVie, UCB, GKC, Bial, Academic grants: EU, IMI EU, Horizon 2020, Parkinson's UK, NIHR, PDNMG, EU (Horizon 2020), Kirby Laing Foundation, NPF, MRC, Wellcome Trust. P.M.‐M., honoraria from National School of Public Health (ISCIII), Britannia, and Editorial Viguera for lecturing in courses; International Parkinson and Movement Disorder Society for management of the Program on Rating Scales; and Bial for advice in clinical‐epidemiological studies. Financial support by the International Parkinson and Movement Disorder Society for attending the IPMDS International Congress 2019. Research grant from the International Parkinson and Movement Disorder Society, for development and validation of the MDS‐NMS. D.W., research funding or support from Michael J. Fox Foundation for Parkinson's Research, Alzheimer's Therapeutic Research Initiative (ATRI), Alzheimer's Disease Cooperative Study (ADCS), the International Parkinson and Movement Disorder Society (IPMDS), and National Institute on Aging (NIA); honoraria for consultancy from Acadia, CHDI Foundation, Clintrex LLC (Aptinyx, Avanir, Otsuka), Eisai, Janssen, Sage, Signant Health and Sunovion; and license fee payments from the University of Pennsylvania for the QUIP and QUIP‐RS. Funding Information: PMM is Co‐Chair of the Program on Rating Scales of the IPMDS. The project was supported by a two‐stage academic peer‐reviewed grant from the International Parkinson's and Movement Disorder's Society (IPMDS) as well as Clinical Research Network (CRN), London South and London North Thames, National Institute of Health Research (for the UK sites). Funding Information: The authors acknowledge grant support from the International Parkinson and Movement Disorder Society to plan, develop, and validate the English version of the MDS‐NMS in an international study. K.R.C. acknowledges support from the NIHR clinical research network and CRN‐supported staff (Dhaval Trivedi, Aleksandra Podlewska, Corinne Borley) for data collection in NHS clinics. A.S. was supported by the National Institute for Health Research UCLH Biomedical Research Centre. D.W. acknowledges the support of the Parkinson's Disease and Movement Disorders Center at the University of Pennsylvania School of Medicine and the involvement of Dr. Jacqui Rick, Sam Rudovsky, and Benjamin Deck in the conduct of the study. This article also presents independent research partly funded by the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre and Dementia Unit at South London and Maudsley NHS Foundation Trust and King's College London, as K.R.C. is funded by these institutions. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, or the Department of Health. Publisher Copyright: © 2020 International Parkinson and Movement Disorder Society Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Background: Non-motor symptoms (NMS) are frequent in Parkinson's disease (PD). Objectives: To estimate the prevalence of NMS and of non-motor fluctuations (NMF) using the Movement Disorders Society-Non-Motor Rating Scale (MDS-NMS) and other scales assessing NMS, and their relationship with sex and PD severity. Methods: Cross-sectional study with a sample of 402 PD patients. The Hoehn and Yahr staging system (HY), Clinical Impression of Severity Index for PD (CISI-PD), MDS-NMS (including NMF- subscale), Non-Motor Symptoms scale (NMSS), and MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) were applied. A NMS was considered present when scored ≥1. Differences in scores by sex and HY, CISI-PD, and MDS-UPDRS severity levels were calculated using Fisher's exact and chi-squared tests. Results: Using the MDS-NMS, NMS were present in 99.7% of patients and the mean number of NMS was 16.13 (SD: 9.36). The most prevalent NMS was muscle, joint or back pain (67.4% of the sample) and the least prevalent was dopamine dysregulation syndrome (2.2%). Feeling sad or depressed was significantly more prevalent in women. Using the MDS-NMS revealed more NMS than the other scales assessing NMS. NMF were present in 41% of the sample, with fatigue being the most prevalent symptom (68.5% patients with NMF), and no differences by sex. Patients with greater PD severity had higher prevalence of NMS than patients with lower severity. Conclusions: Almost all patients with PD experience NMS, and many experience NMF. Prevalence rates for NMS using the MDS-NMS are higher than on other scales used and increase with higher disease severity.

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