Parkinson Disease Stage Affects Which Symptoms Impact HRQoL for Patients

Across levels of disease severity, patients with Parkinson disease (PD) and their care partners rank motor symptoms as the greatest contributor to health-related quality of life (HRQoL), according to the findings of a systematic review published in the journal Neurology.

People with PD experience both motor and nonmotor symptoms that affect their and their care partner’s HRQoL. To optimize HRQoL, clinicians should understand which symptoms contribute most to HRQoL such that care can be personalized to obtain the best results.

A team of researchers from Rush University in the United States performed this convergent integrated mixed-methods systematic review with the aim of analyzing qualitative and quantitative evidence of which PD symptoms affect HRQoL.

A total of 70 studies published between 1997 and 2022 were included in this review. The studies were primarily conducted in Europe (47.1%), North America (27.1%), and Asia (21.4%) in the outpatient setting (97.1%) and were of quantitative designs (75.7%).

In the qualitative studies, 2 motor (tremor and gait, balance, posture, and/or falls) and 2 nonmotor (cognition and fatigue) symptoms were cited in 100% of studies as affecting HRQoL of patients with PD and their care partners.

Stratified by PD stage, the most endorsed symptoms for patients with early-stage PD included tremor; gait, balance, posture, and/or falls; mood; and cognition. There was insufficient evidence about care partner perceptions of HRQoL for early-stage PD.

Patients with advanced PD and their care partners cited gait, balance, posture, and/or falls as affecting HRQoL the most.

In quantitative studies, 1 motor (motor functionality) and 2 nonmotor (mood and cognition) symptoms were found to affect HRQoL of patients with PD and their care partners the most.

Stratified by stage, patients early-stage PD and their care partners cited 8 symptoms as affecting HRQoL the most.

The motor symptoms included:

• tremor,
• rigidity,
• bradykinesia,
• overall motor symptoms, and
• motor functionality.

The nonmotor symptoms included:

• mood,
• nonmotor functionality, and
• cognition.

Additional symptoms endorsed by a smaller sample of patients with PF and their care partners included:

• difficult handwriting;
• speech disorder;
• arm swinging decrease;
• gait, balance, posture, and/or falls;
• dyskinesia;
• dystonia;
• motor fluctuations;
• urogenital;
• gastrointestinal;
• nighttime sleep disorder;
• mood;
• cognition;
• fatigue;
• hyposmia, anosmia, and/or ageusia;
• pain;
• restless legs syndrome;
• sensory complaints; and
• visual problems.

For advanced PD, patients cited pain as the symptom most affecting their HRQoL whereas their care partners thought psychiatric symptoms most affected their HRQoL.

In an analysis that integrated qualitative and quantitative study results, the researchers found that mood was the most dominant symptom affecting HRQoL in early PD. In advanced PD, patients thought pain was the most important symptom and their care partners thought psychiatric symptoms were the most important.

A main limitation of this study was that the data were too diverse, making a meta-analysis infeasible.

“[T]he effect of PD symptoms on the HRQoL of PwP [people with Parkinson disease] and CP [care partners] differs mainly in its variety and the advanced disease stage. Therefore, symptom management needs to consider the experiences of all individuals so that high HRQoL levels can be achieved.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.