Non Motor Symptoms In Patients With parkinson ' s Disease In Baghdad Hospitals

Al-Kindy College Medical Journal 2017: Vol.13 No. 1 122 www.kmjub.com ABSTRACT Background:Parkinson’disease(PD) is a neurodegenerative disorder of the central nervous system characterized by resting tremor, bradykinesia, cogwheel rigidity, and impairment of postural reflexes; the frequency of PD increases with aging.Clinically Parkinson's disease characterized by two groups of symptoms: motor and nonmotor symptoms.Non-motor symptoms can be categorized as autonomic, cognitive/psychiatric (may include depression, dementia, anxiety, hallucinations), sensory and rapid eye movements (REM) sleep behavior disorder (RBD). Objectives:The objectives of this study are to find out the frequency of the non-motor symptoms of idiopathic Parkinson disease in a group of patients in Baghdad hospitals. Type of the study:A cross sectional study with analytic elements, Methods: It was conducted in movement disorders clinic in neuroscience hospital, outpatient clinic at Baghdad teaching hospital and AL-Kadhumain teaching hospital during the period between the 1st. of December 2013 through July 2014. One hundred and two patients diagnosed as idiopathic Parkinson disease by a consultant neurologist.. Results:The study found that the mean age of patients with Idiopathic Parkinson disease was 60 years. Among them, two thirds of patients (68/102) were males, and 55 % (56/102) of patients were in advanced stage of the disease. The study also mentioned the percentage of non-motor symptoms of Idiopathic Parkinson disease and they ranged from the most frequent symptom[constipation(80%)] to the least frequent[bowel incontinence(16%)].Also the study shows the distribution of symptoms according to gender and the study found no significant difference between males and females. The study finds that there is no significant difference in symptoms development along the period of disease progression except for bowel incontinence [30.4 % (14/46) in early disease progression compared to 3.6 %( 2/56) in advanced disease] and sexual interest [34.8 %( 16/46) in early disease progression compared to3.6 (2/56) in advanced disease]. Conclusions:Non motor symptoms of Parkinson disease is so frequent and represent a major burden on patients' quality of life and the study recommends a more concentration on them in the future.

arkinson's disease (PD) is a neurodegenerative disorder of the central nervous system characterized by resting tremor, bradykinesia, cogwheel rigidity, and impairment of postural reflexes.The syndrome was first described by the British physician James Parkinson in An Essay on the Shaking Palsy published in 1817.The eponymous designation was given some years later by Jean-Martin Charcot, the famous director of Paris's Salpeˆtrie´re Hospital i,ii .The neuropathology of PD is characterized by neuronal loss and neuromelanin loss in the SubstantiaNigracompacta, as well as accumulation of intraneuronaleosinophilic inclusions (Lewy bodies) in the same structure.There is characteristic topography to the neuronal loss in the SubstantiaNigracompacta with cell loss occurring first in the ventrolateral tier and then progressing to involve the dorsomedial tier (Lowe et al, 1997).PD also involves loss of cells in other pigmented catecholaminergic nuclei, including the ventral tegmental area, locus caeruleus and the serotonergic raphe nucleus iii .The objectives of this study are to find out the frequency of the non-motor symptoms of idiopathic Parkinson disease in a group of patients in Baghdad hospitals.

Methods:
Study design: A cross sectional study with analytic elements, conducted in movement disorders clinic in neuroscience hospital, outpatient clinic at Baghdad teaching hospital and AL-Kadhumain teaching hospital during the period between the 1st. of December 2013 and July 2014.
One hundred and two patients diagnosed as idiopathic Parkinson disease by a consultant neurologist; the patients were considered as cases of idiopathic Parkinson disease when they had bradykinesia plus either of the fallowing 2 :-   .The prevalence in male patients were (52.9%) and in female patients (41.2%).Early disease course accounted for (39.1%) and advanced stage accounted for (57.1%) of patients who had this symptom..The prevalence of restless leg syndrome in our study was (37.3%) in Parkinson's patients in compares to (25.5%) in control population which was not significant change and this result was so close to the results of Verbaan D. et al xxii .the prevalence in male patients was (41.2%) and in female patients was (29.4%) and the prevalence of early stage disease progression was (26.1%) in compares to advanced disease which was (46.4%).Conclusion :Non motor symptoms of Parkinson disease is so frequent in the collected group of patients affecting the quality of their lives.There is no significant difference between the age groups of patients of Parkinson's disease and the development of non-motor symptoms of Parkinson's disease.There is no significant difference between males and females in developing non-motor symptoms of Parkinson's disease.There is no significant difference in developing the non-motor symptoms of Parkinson's disease and the progression of the disease (early or late) except for decrease libido which was more prominent in advanced stage of the disease and fecal incontinence which was more in early stage of the disease.

Table ( 3
-3) shows the distribution of symptoms according to gender and the study found no significant difference between males and females.The study finds that there is no significant difference in symptoms development along the period of disease progression except for bowel incontinence [30.4 %(14/46)in early disease progression compared to 3.6 %( 2/56) in advanced disease] and sexual interest [34.8 %( 16/46) in early disease progression compared to3.6 (2/56) in advanced disease].(Table 3-4).

Table ( 3
-1)The distribution of patients according to demographic characteristics.

Table ( 3
-2)The distribution of patients according to the non-motor symptoms.Non motor symptoms of Parkinson disease are common, but they are under estimated in clinical practice, because of the lack of spontaneous complaints by the patients, and partly because of the absence of systemic questioning by health care professionals.The prevalence of anosmia or hyposmia in the present study was (56.9%) which was close to the result reported by Braack H et al, and Walters E, Braak H. Insomnia represents one of the most common symptoms of sleep disorders in Parkinson's disease.www.kmjub.comThe prevalence of insomnia in this study was (66.7%) which was close to the results of Tandberg E. et al xix . .The prevalence of REM sleep Behavior Disorder in our study was (49.0%) which comes so closely to the results of Comella CL. et al and Gagnon JF. et al % Non Motor Symptoms ….Ahmed Tahseen Muslim et al Al-Kindy College Medical Journal 2017: Vol.13 No. 1 125 www.kmjub.comxviii .