ReviewNon-motor symptoms of Parkinson’s disease in China: A review of the literature
Introduction
As the second most common neurodegenerative disorder after Alzheimer’s disease (AD), Parkinson’s disease (PD) is characterized by the classic motor symptoms of tremor, rigidity, bradykinesia and postural instability. However, a spectrum of non-motor symptoms (NMSs), including altered sensations, dysautonomia, neurobehavioral disorders and sleep disturbances, frequently occur throughout the course of PD. These NMSs may occur concurrently with the motor symptoms or precede the onset of motor symptoms by several years [1]. In Advanced PD, NMSs have been recognized as significant factors associated with impaired quality of life [2], and impose a considerable economic burden on patient families and society [3]. In contrast to the motor symptoms of PD, NMSs are often under-recognized and poorly managed in clinical practice [4], only recently have been thought as important enough to study by clinicians and researchers, as reflected by the growing number of published studies from Han Chinese over the last decade.
In order to access these Chinese studies, we searched MEDLINE (1948 to present), EMBASE (1980 to present) and Chinese main medical databases: Chongqing VIP Database (VIP), Wan Fang Database, Chinese hospital knowledge database (CHKD), Chinese biomedical database (CBM-disc, 1978 to present) to locate all relevant papers published between 1966 and May 2011 relating to PD. The keywords used in the search included: “Parkinson’s disease”,“Parkinsonism”, “non-motor symptoms” and “China” or “Chinese”. Every paper relating to PD was reviewed and the reference lists were also examined to identify possible missed studies. No language restriction was applied. The following criteria were used to identify relevant studies for this review: (1) Clinical diagnosis of PD was established according to the United Kingdom brain–bank criteria; (2) They had a series of scales for measuring the non-motor symptoms rather than descriptive studies.
Section snippets
Epidemiology on NMSs in PD
NMSs of patients with PD were generally not well recognized during routine clinical visits. In a prospective study of 101 PD patients, neurologists failed to identify the presence of depression, anxiety, and fatigue more than half of the time and failed to recognize sleep disturbance in 40% of patients [5]. Chaudhuri et al developed and validated a self-completed non-motor symptom questionnaire (NMSQuest2006) [6] and a non-motor symptom scale (NMSS2007) [7]. By using these tools, a spectrum of
Pathophysiological basis of NMSs in PD
To date, the underlying pathological and biochemical mechanisms for much of the NMSs remain incompletely understood. In addition to dopaminergic dysfunction, degeneration of non-dopaminergic (i.e.noradrenergic, serotoninergic and cholinergic) systems may contribute to NMSs in PD [14]. Braak hypothesis on pathological staging of PD suggests that the disease generally begins distally from the enteric nervous system in addition to the dorsal motor nucleus of the glossopharyngeal and vagal nerves
Olfactory dysfunction
Hyposmia occurs in up to 90% of PD patients in the West and involves several features including identification, discrimination and impairment of odor threshold. It does not seem to be correlated with disease stage or duration, and is independent of antiparkinsonian medications [22], [23]. Using the “five odors olfactory detection arrays”, identification of the olfactory thresholds of Chinese PD patients were significantly elevated compared to those of healthy controls [24]. Atrophy in the
Conclusions
In summary, NMSs, including sensory symptoms, dysautonomia, neurobehavioral disorders, and sleep disturbances are also commonly experienced symptoms among Chinese PD patients. We found that there were not only common features, but also some differences on NMSs between Chinese patients and those in the West (Table 2). However, due to the absence of collaboration between different centers or sites, research into NMSs of PD in China has been limited to some retrospective studies with small sample
Acknowledgements
The authors would like to thank Mr. Ning Song from University of New South Wales for English proof reading. This work was supported by grants from the National Program of Basic Research (2011CB504104) of China, Shanghai Key Project of Basic Science Research (10411954500), Shanghai Key Discipline Program (S30202), and Program for Outstanding Medical Academic Leader (LJ 06003).
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