Clinical problems in non-fluctuating patients with Parkinson's disease: A community-based study

OBJECTIVE: To investigate the frequency of non-fluctuators in a community-b ased prevalence study of Parkinson's disease (PD) and to describe disabilit y, non-motor problems, and health-related quality of life in patients with PD with and without motor fluctuations, and compare the findings to those o f two control groups. METHODS: The study involved 245 patients with PD who were participating in a prevalence study and two control groups (100 healthy elderly individuals and 100 patients with diabetes mellitus [DM]). Data were obtained through n eurologic examination and a semistructured interview, and by the use of sev eral questionnaires. RESULTS: In this group of unselected patients with PD, 78% did not experien ce motor fluctuations. Mean duration of treatment with levodopa was 6.3 yea rs. Patients with motor fluctuations had a lower age at onset of disease, l onger duration of disease, and a higher daily levodopa dose than patients w ithout fluctuations. Among the non-fluctuating patients, we found more deme ntia and a higher age at prevalence day. Disability (assessed by the Unifie d Parkinson's Disease Rating Scale subscales for activities of daily living and motor function and the Hoehn and Yahr stage) was similar in fluctuator s and non-fluctuators. Depression, sleep disturbances, and fatigue were equ ally frequent in both patient groups. The occurrence of these difficulties was clearly more frequent among non-fluctuating patients with PD than among the control subjects. CONCLUSION: Most patients in the general population who have PD do not expe rience dose-dependent motor fluctuations. Severity of motor disability and neuropsychiatric manifestations are as important in non-fluctuators as in f luctuators. Patients without motor fluctuations have more depression, sleep disturbances, fatigue, and a poorer health-related quality of life than pa tients with DM, and healthy elderly individuals. This also underlines the i mportance of developing better management and treatment strategies for this group of patients with PD.