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Characterization of Non-Motor Fluctuations Using the Movement Disorder Society Non-Motor Rating Scale

Research output: Contribution to journalArticlepeer-review

Daniel Johannes van Wamelen, Silvia Rota, Anette Schrag, Alexandra Rizos, Pablo Martinez-Martin, Daniel Weintraub, Kallol Ray Chaudhuri

Original languageEnglish
Pages (from-to)932-940
Number of pages9
JournalMovement Disorders Clinical Practice
Issue number7
Early online date5 Aug 2022
Accepted/In press3 Jul 2022
E-pub ahead of print5 Aug 2022
PublishedOct 2022

Bibliographical note

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 from where the data for the current analyses were obtained. The authors acknowledge support from the NIHR Clinical Research Network and CRN‐supported staff for data collection in NHS clinics and of the UCL/H Biomedical Research Council. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Funding Information: In the past year D.v.W. has received speaker fees from Bial and Britannia pharmaceuticals, and research grants from NIHR BRC and CHDI; S.R. has nothing to disclose; A.S. has nothing to disclose; A.R. has received support from the National institute of Health Research (NIHR) Clinical Research Network (CRN) South London, Guy's Hospital, Great Maze Pond, London UK and International Parkinson and Movement Disorder Society (MDS); P.M.M. has nothing to disclose; In the past year D.W. has received 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), International Parkinson and Movement Disorder Society (IPMDS), National Institute on Health (NIH), Parkinson's Foundation; U.S. Department of Veterans Affairs and Acadia Pharmaceuticals; honoraria for consultancy from Acadia Pharmaceuticals, Alkahest, Aptinyx, Cerevel Therapeutics, CHDI Foundation, Clexio, Clintrex LLC (Otsuka), EcoR1 Capital, Eisai, Ferring, Gray Matter Technologies, Great Lake Neurotechnologies, Intra‐Cellular Therapies, Janssen, Merck, Sage, Scion, Signant Health and Vanda; and license fee payments from the University of Pennsylvania for the QUIP and QUIP‐RS. K.R.C. reports advisory board for AbbVie, UCB, GKC, Bial, Cynapsus, Lobsor, Stada, Zambon, Profile Pharma, Synovion, Roche, and Therevance, Scion, as well as honoraria for lectures for AbbVie, Britannia, UCB, Zambon, Novartis, Boeringer Ingelheim, Bial, Kyowa Kirin, SK Pharma, and frants (Investigator Initiated) from Bial, EU Horizon 2020, Parkinson's UK, NIHR, Parkinson's Foundation, Wellcome Trust, and royalties or licenses (ongoing) from Oxford (book), Cambridge publishers (book), MAPI institute (KPPS, PDSS 2), and payment for expert testimony for the General Medical Council (UK). Publisher Copyright: © 2022 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC. on behalf of International Parkinson and Movement Disorder Society.


King's Authors


Background: Non-motor fluctuations (NMF) in people with Parkinson's disease (PwP) are clinically important yet understudied. Objective: To study NMF in PwP using both the Movement Disorder Society Non-Motor Rating Scale (MDS-NMS) NMF subscale and wearable sensors. Methods: We evaluated differences in overall burden of NMF and of specific NMF across disease durations: <2 years (n = 33), 2–5 years (n = 35), 5–10 years (n = 33), and > 10 years (n = 31). In addition, wearable triaxial sensor output was used as an exploratory outcome for early morning “off” periods. Results: Significant between-group differences were observed for MDS-NMS NMF total scores (P < 0.001), and specifically for depression, anxiety, fatigue and cognition, with both NMF prevalence and burden increasing in those with longer disease duration. Whereas only 9.1% with a short disease duration had NMF (none of whom had dyskinesia), in PwP with a disease duration of >10 years this was 71.0% (P < 0.001). From a motor perspective, dyskinesia severity increased evenly with increasing disease duration, while NMF scores in affected individuals showed an initial increase with largest differences between 2–5 years disease duration (P < 0.001), with plateauing afterwards. Finally, we observed that the most common NMF symptoms in patients with sensor-confirmed early morning “off” periods were fluctuations in cognitive capabilities, restlessness, and excessive sweating. Conclusions: Non-motor fluctuations prevalence in PwP increases with disease duration, but in a pattern different from motor fluctuations. Moreover, NMF can occur in PwP without dyskinesia, and in those with NMF the severity of NMF increases most during years 2–5 after diagnosis.

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