Study On Correlations Between Non-motor Symptoms In Patients With Different Motor Phenotypes Of Parkinson’’s Disease

Background: Parkinson’s disease(PD)is a movement disorder characterized by a decrease in dopaminergic neurons in the nigrostriatal system.It is the second most common degenerative disease of the central nervous system in the elderly.It is well known for its motor symptoms,including bradykinesia,myotonia,resting tremors,and posture gait abnormalities.In recent years,Non-motor symptoms of PD have gradually attracted the attention of clinicians.Common non-motor symptoms include autonomic nervous system symptoms,pain,mood disorders,olfactory dysfunction,sleep disorders,and cognitive dysfunction.Because of the heterogeneity of the clinical manifestations of PD patients,PD can be divided into tremor-dominant(TD)and postural instability and gait difficulty(PIGD)according to the difference in their main motor symptoms.There may be differences in non-motor symptoms between PD patients with different motor phenotypes.Objective: To compare the difference in the incidence and severity of non-motor symptoms in PD patients with different motor phenotypes,and to further study the influencing factors.Methods: From October 2016 to April 2018,91 patients were diagnosed as primary Parkinson’s disease in Jiangsu Subei People’s Hospital were concluded in this research.PD patients were administrated with non-motor scales and motor scales,including non-Motor Symptoms Questionnaire(NMSQ),Autonomic Symptom Scale(SCOPA-AUT),Hamilton Depression Rating Scale(HDRS),Pittsburgh Sleep Quality Index(PSQI),MoCA,and Mini-Mental State Scale(MMSE),the unified Parkinson’s Disease Rating Scale(UPDRS)II and III,according to UPDRS II and III score,12 cases of tremor type(TD),53 cases of postural instability and gait difficulty(PIGD)and 16 cases uncertain type were divided,the differences between the base line and scores of the motor and non-motor scales of the TD and PIGD groups of PD patients were compared,and the influencing factors of the differences were further analyzed.Results: 1.There was no significant difference in age and gender between the two groups(P>0.05),and the education level(P=0.031)was different.The PIGD group had higher education level than the TD group.2.There was no significant difference in the course of disease between the two groups(P>0.05).The mean age of onset(P=0.038),H-Y grade(P=0.011),and UPDRS-III total score(P=0.011)were statistically different.The average age of onset,H-Y grade,and total score of UPDRS-III were higher in the PIGD group than TD group.3.There was no significant difference in MMSE,HDRS,FSS and PSQI scores between the two groups(P>0.05),but the scores of HDRS and PSQI in the PIGD group were higher than those in the TD group.The MoCA scores were statistically significant(P= 0.013)between two groups,considering the difference in educational level between the two groups of patients,the education level was introduced into the covariate and analyzed again.There was no statistical difference between the two groups(P=0.301).After the correction of the educational level,the average score of the TD group was still higher.The average score of SCOPA-AUT score(P=0.019)and NMSQ score(P=0.009)were statistically different.The SCOPA-AUT score and NMSQ score of PIGD group were higher than those of TD group.4.Further analysis of the influencing factors of MoCA score,NMSQ score and SCOPA-AUT score,we found that the education level and UPDRS-III total score are the influencing factors of MoCA score,P value is <0.001,0.003 respectively;HDRS score and H-Y grade are the influencing factors of the SCOPA-AUT score,P values were <0.001 and 0.044,respectively;Age,HDRS score,FSS score and UPDRS-III total score were the influencing factors of NMSQ score,P values were 0.031,<0.001,0.008,0.005,respectively.Conclusion: Compared with TD type PD patients,PIGD type patients have higher age of onset and H-Y classification,and the motor symptoms are more serious,the incidence of non-motor symptoms are higher,the impairment of autonomic nervous symptoms is more obvious,and have a trend of cognitive impairment,depression and sleep disorders.Further analysis shows that the age,severity of depression,fatigue and motor symptoms are influencing factors of non-motor symptoms,the occurrence of depression and H-Y scale are the influencing factors of the occurrence of autonomic nervous symptoms,the level of education and the severity of motor symptoms are the influencing factors of the cognitive impairment.