Top Motor and Non-Motor Complaints in Patients with Parkinson´s Disease

José Fidel Baizabal-Carvallo^1*Marlene Alonso-Juarez²Robert Fekete³

• ¹University of Guanajuato, Guanajuato, Mexico
• ²Instituto Politecnico Nacional, Mexico City, Mexico
• ³New York Medical College, Valhalla, United States

Background: Parkinson´s disease (PD) is characterized by several motor and non-motor manifestations. These variable neurological complaints have diverse intensity and cause various degrees of disability. Objectives Methods: We aimed to assess the top-3 most troublesome neurological complaints in patients with PD and correlated with demographic and clinical variables including the cognitive status assessed by the Montreal Cognitive Assessment (MoCA). Patients were asked about their 3 most troublesome neurological complaints after reviewing all motor and non-motor symptoms. Responses were divided into 3 tiers. Results: We studied 230 consecutive patients with PD. There were 130 (56.5%) males with a mean age at evaluation of 67.7 ± 11.06 years. The most common neurological complaints in the top tier were: 1) tremor (n=80, 34.8%), 2) gait problems (n=37, 16.1%) and 3) dyskinesia (n=17, 7.4%). Speech difficulties, dyskinesia and insomnia became prominent after 5 or 10 years since onset. A total of 159 (69.1%) patients endorsed "at least one non-motor symptom" in their top-3 tier. Pain (n=29, 12.6%), anxiety (n=25, 10.8%), and insomnia (n=25, 10.8%) were the most common non-motor symptoms. The presence of non-motor symptoms in the top-3 tier was associated with decreased cognitive status (MoCA <25 points) but not with age, sex, or disease evolution time. Cognitive impairment was a predictor of non-motor symptoms in their top-3 tier, OR: 3.88 (95% C.I. 1.647 to 9.169). Cluster analysis in patients with at least one non-motor symptom, identified 4 groups: males or females with short evolution, postural-instability gait difficulties (PIGD) phenotype and a dyskinetic group. The latter two associated with higher frequency of fatigue, insomnia, pain, and anxiety. Conclusions: Overall, tremor was the most troublesome symptom in patients with PD, but variability was high. About 69% of patients had at least one non-motor symptom in their top-3 complaints, which was associated with abnormal cognitive status. Speech difficulties, dyskinesia and insomnia became prominent with disease progression. In patients with non-motor symptoms in the top-3 tier, those with PIGD and prominent dyskinesia had a higher frequency of fatigue, insomnia, pain, and anxiety suggesting a clustering effect of non-motor symptoms with these motor presentations.