Non-motor Symptom Burden and Its Clinical Correlates in Parkinson’s Disease: A Cross-sectional Study in Indonesia
DOI:
https://doi.org/10.36452/jkdoktmeditek.v32i4.4204Keywords:
Hoehn & yahr stage, non-motor symptoms, NMS-Q, parkinson’s diseaseAbstract
Introduction: Non-motor symptoms (NMS) are increasingly recognized to have disabling impact on the quality of life of idiopathic Parkinson’s disease (PD) patients, comparable to motor symptoms. However, their relationship with clinical and demographic factors remains obscure in local populations. Purpose: To determine the prevalence of NMS in idiopathic PD and evaluate their correlation with clinical variables, including disease duration, Hoehn & Yahr (H&Y) stage, and PD subtype. Methods: This cross-sectional study consecutively included idiopathic PD subjects evaluated between July-October 2025. Data collected included age, gender, age at onset, disease duration, H&Y stage, and PD subtype. NMS were assessed using the Indonesian version of Non-Motor Symptoms Questionnaire (NMS-Q). Correlation and multiple linear regression analyses performed. Results: Fifty-three subjects were included (mean age 66.9±10.5 years; 50.9% male). Median disease duration was 5 years (IQR 1–7.5), with majority in H&Y stage 2 (49%). Mean total NMS-Q score was 10.7±5.2. The most frequent NMS was urinary urgency (66%), with urinary domain being the most affected (64.2%). Total NMS-Q scores correlated with H&Y stage (r=0.427, p=0.001) and disease duration (r=0.309, p=0.025). Only H&Y stage independently predicted total NMS-Q scores (B=2.657, p=0.010). Conclusion: This study provides additional evidence from an Indonesian population using a standardized assessment tool, demonstrating that disease severity is an independent predictor of NMS burden, thus highlighting the importance of early and systematic evaluation of NMS in idiopathic PD.
References
1. Armstrong MJ, Okun MS. Diagnosis and treatment of Parkinson disease: a review. JAMA. 2020;323(6):548-60. DOI: https://doi.org/10.1001/jama.2019.22360
2. Simonet C, Schrag A, Lees AJ, Noyce AJ. The motor prodromes of Parkinson's disease: from bedside observation to large-scale application. J Neurol. 2021;268(6):2099-108. DOI: https://doi.org/10.1007/s00415-019-09642-0
3. Munhoz RP, Moro A, Silveira-Moriyama L, Teive HAG. Non-motor signs in Parkinson's disease: a review. Arq Neuropsiquiatr. 2015;73(5):454-62. DOI: https://doi.org/10.1590/0004-282X20150029
4. Váradi C. Clinical features of Parkinson's disease: the evolution of critical symptoms. Biology (Basel). 2020;9(5):103. DOI: https://doi.org/10.3390/biology9050103
5. Wu SL, Liscic RM, Kim S, Sorbi S, Yang YH. Nonmotor symptoms of Parkinson's disease. Parkinsons Dis. 2017;2017:4382518. DOI: https://doi.org/10.1155/2017/4382518
6. Oikonomou E, Paparrigopoulos T. Neuropsychiatric manifestations in Parkinson's disease. Psychiatriki. 2015;26(2):116-30. DOI: https://doi.org/10.1155/2018/1517807
7. Upneja A, Paul BS, Jain D, Choudhary R, Paul G. Anxiety in Parkinson's disease: Correlation with depression and quality of life. J Neurosci Rural Pract. 2021;12(2):323-8. DOI: https://doi.org/10.1055/s-0041-1722840
8. Coe S, Franssen M, Collett J, Boyle D, Meaney A, Chantry R, et al. Physical activity, fatigue, and sleep in people with Parkinson's disease: A Secondary per protocol analysis from an intervention trial. Parkinsons Dis. 2018;2018:1517807. https://doi.org/10.1155/2018/1517807
9. Sobreira-Neto MA, Pena-Pereira MA, Sobreira EST, Chagas MHN, de Almeida CMO, Fernandes RMF, et al. Chronic insomnia in patients with Parkinson disease: Which associated factors are relevant? J Geriatr Psychiatry Neurol. 2020;33(1):22-7. https://doi.org/10.1177/0891988719856687
10. Schapira AHV, Chaudhuri KR, Jenner P. Non-motor features of Parkinson disease. Nat Rev Neurosci. 2017;18(7):435-50.
11. Radad K, Moldzio R, Krewenka C, Kranner B, Rausch WD. Pathophysiology of non-motor signs in Parkinson's disease: some recent updating with brief presentation. Explor Neuroprot Ther. 2023;3:24-46. DOI: https://doi.org/10.37349/ent.2023.00036
12. International Parkinson and Movement Disorder Society. Non-Motor Symptoms Questionnaire (NMSQuest). Milwaukee (WI): International Parkinson and Movement Disorder Society; [cited 2025 Nov 16]. DOI: https://www.movementdisorders.org/MDS/MDS-Rating-Scales/Non-Motor-Symptoms-Questionnaire.htm
13. Chaudhuri KR, Martinez-Martin P, Schapira AHV, Stocchi F, Sethi K, Odin P, et al. International multicenter pilot study of the first comprehensive self-completed non-motor symptoms questionnaire for Parkinson's disease: the NMSQuest study. Mov Disord. 2006;21(7):916-23. DOI: https://doi.org/10.1002/mds.20844
14. Martinez-Martin P, Schapira AHV, Stocchi F, Sethi K, Odin P, MacPhee G, et al. Prevalence of non-motor symptoms in Parkinson's disease in an international setting: A Study using non-motor symptoms questionnaire in 545 patients. Mov Disord. 2007;22(11):1623-9. https://doi.org/10.1002/mds.21586
15. Špica V, Pekmezović T, Svetel M, Kostić VS. Prevalence of non-motor symptoms in young-onset versus late-onset Parkinson's disease. J Neurol. 2013;260(1):131-7. DOI: https://doi.org/10.1007/s00415-012-6600-9
16. Bonnet AM, Jutras MF, Czernecki V, Corvol JC, Vidailhet M. Nonmotor symptoms in Parkinson's disease in 2012: relevant clinical aspects. Parkinsons Dis. 2012;2012:198316. DOI: https://doi.org/10.1155/2012/198316
17. Uchiyama T, Sakakibara R, Yamamoto T, Ito T, Yamaguchi C, Awa Y, et al. Urinary dysfunction in early and untreated Parkinson's disease. J Neurol Neurosurg Psychiatry. 2011;82(12):1382-6. https://doi.org/10.1136/jnnp.2011.241075
18. Zis P, Erro R, Walton C, et al. The range and nature of non-motor symptoms in drug-naive Parkinson's disease patients: a state-of-the-art systematic review. NPJ Parkinsons Dis. 2015;1:15013. DOI: https://doi.org/10.1038/npjparkd.2015.13
19. Ravan A, Ahmad FH, Chabria S, Gadhari M, Sankhla CS. Non-motor symptoms in an Indian cohort of Parkinson's disease patients and correlation of progression of non-motor symptoms with motor worsening. Neurol India. 2015;63(2):166-74. DOI: https://doi.org/10.4103/0028-3886.156276
20. Liu WM, Lin RJ, Yu RL, Tai CH, Lin CH, Wu RM. The impact of nonmotor symptoms on quality of life in patients with Parkinson's disease in Taiwan. Neuropsychiatr Dis Treat. 2015;11:2865-73. DOI: https://doi.org/10.2147/NDT.S88968
21. Verbaan D, Marinus J, Visser M, van Rooden SM, Stiggelbout AM, van Hilten JJ. Patient-reported autonomic symptoms in Parkinson disease. Neurology. 2007;69:333-41. DOI: https://doi.org/10.1212/01.wnl.0000266593.50534.e8
22. Kummer A, Cardoso F, Teixeira AL. Loss of libido in Parkinson's disease. J Sex Med. 2009;6(4):1024-31. DOI: https://doi.org/10.1111/j.1743-6109.2008.01083.x
23. Karri A, Rana AQ, Parvaiz A, Jesudasan RA, Lodin H, Rana R, et al. Prevalence of sexual dysfunction in Parkinson's disease: a systematic review and meta-analysis. Ann Indian Acad Neurol. 2019;22(4):460-5. DOI: https://doi.org/10.4103/aian.AIAN_10_19
24. Barone P, Antonini A, Colosimo C, Marconi R, Morgante L, Avarello TP, et al. The PRIAMO study: a multicenter assessment of non-motor symptoms and their impact on quality of life in Parkinson's disease. Mov Disord. 2009;24(11):1641-9. DOI: https://doi.org/10.1002/mds.22643
25. Vongvaivanich K, Nidhinandana S, Udommongkol C, Chairungsaris P, Chinvarun Y, Wongmek W, Suphakasem S, Suwantamee J, Sithinamsuwan P. Non-motor symptoms in Thai patients with Parkinson's disease studied at Phramongkutklao Hospital. J Med Assoc Thai. 2014;97(Suppl 2):S159-67.
26. Broen MP, Narayen NE, Kuijf ML, Dissanayaka NNW, Leentjens AFG. Prevalence of anxiety in Parkinson's disease: a systematic review and meta-analysis. Mov Disord. 2016;31(8):1125-33. DOI: https://doi.org/10.1002/mds.26643
27. Dissanayaka NNW, White E, O'Sullivan JD, Marsh R, Pachana NA, Byrne GJ. The clinical spectrum of anxiety in Parkinson's disease. Mov Disord. 2014;29(8):967-75. DOI: https://doi.org/10.1002/mds.25937
28. Fernandes M, Pierantozzi M, Stefani A, Cattaneo C, Bonizzoni EA, Cerroni R, et al. Frequency of non-motor symptoms in Parkinson's patients with motor fluctuations. Front Neurol. 2021;12:678373. DOI: https://doi.org/10.3389/fneur.2021.678373
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Dr. dr. Rocksy Fransisca V Situmeang, Sp.N (K), dr. Nadia Gabriella
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
