The non-motor side of the honey-moon period of Parkinson’s disease

Objective: To explore the non-motor side of the honey-moon period in Parkinson’s disease (PD) and its impact on quality of life (QoL). Background: Although there has been increasing evidence that non-motor symptoms (NMS) are integral to PD, very little is known about NMS during the (motor) honey-moon period of PD and, to our knowledge, there are no longitudinal studies focusing on the progression of the whole NMS complex since the earliest stage, when patients receive the diagnosis and are still untreated. Methods: Consecutive, de-novo (disease duration less than 2 years and never treated with dopaminergic drugs) PD patients have been enrolled and assessed at baseline (T0) and 2 (T1) and 4 (T2) years after the enrollment. All patients were assessed with the UPDRS3 (motor scale) and the NMSQuest and completed the PDQ39, as measure of their QoL. Results: Nearly all NMS increased over time, while the motor burden remained fairly stable, indicative of an optimal (motor) response to dopaminergic drugs. Further correlations revealed the total number of NMS to be associated with QoL (rho: 0.39; p<0.01). Specifically, depression, anxiety, loss of interest and pain were the most significant factors contributing to worse QoL (Rho: 0.58, 0.52, 0.44, and 0.43 respectively, all p<0.01). No correlations were observed with motor scores. Conclusions: NMS tend to increase over the first 4 years from diagnosis in PD patients and significantly affect their QoL. Specifically, certain neuropsychiatric symptoms and pain contribute the most to worse QoL in PD patients during their "honey-moon" period.