Clinical Features Analysis Of Non-motor Symptoms In Progressive Supranuclear Palsy

BackgroundProgressive Supranuclear Palsy(PSP)is a common atypical Parkinson's syndrome,whose onset age is older than Parkinson's disease,generally 50 to 70 years old,with an average course of 5-9 years,and its incidence in China is still unknown.There are relatively few studies on non-motor symptoms(NMS)in PSP and different researches showed controversial results.Some of the non-motor symptoms of PSP patients may appear years before the motor symptoms and seriously affect the quality of life of patients.A total of 30 patients with PSP were included in the study of PRIAMO(PaRkinsondIseAse non-motor symptoms).It was found that the most common NMS among PSP patients were gastrointestinal symptoms and fatigue and the incidence of NMS in PSP was significantly higher than that of PD patients.A study conducted in South Korea on atypical Parkinson's disease and Parkinson's disease showed that the highest incidence of non-motor symptoms of PSP was attention/memory disorder.In addition,mood/apathy,attention/memory and gastrointestinal tract symptoms in PSP are rapidly advanced.Caregiver burden mainly refers to the physical,psychological and economic pressure caused by family members in the process of taking care of patients.This chronic stress will inevitably have an impact on caregivers' daily lives and health,and may even disrupt family and social relationships.A study of the factors affecting caregiver burden in patients with advanced primary Parkinson's disease and progressive supranuclear palsy showed that depression and psychological stress were common in caregivers of patients with advanced PD and PSP.However,the study also found that motor impairment,cognitive impairment and depression were not significantly correlated with caregiver burden.At present,there are relatively few studies on non-motor symptoms of PSP and the results of different studies are different.The purpose of this study was to make a clinical analysis of the non-motor symptoms of sporadic PSP,compare the non-motor symptoms of PSP and PD,and study the relationship between clinical variables and the daily life ability of patients and the burden of caregivers.This research is to provide more clinical data for the study of PSP non-motor symptoms and improve the clinical attention to PSP NMS.The NMS in PSP need early diagnosis,early intervention,and we need to improve the patients' quality of life as much as possible and reduce the burden of caregivers.ObjectiveTo investigate the incidence and severity of non-motor symptoms in PSP patients and compared them with PD patients.Compare the non-motor symptoms between PSP-P group and the PSP-RS group.To study the correlation between clinical variables in PSP patients and further identify possible risk factors affecting the burden on caregivers.MethodsTwenty-nine patients with PSP who were admitted to the outpatient and inpatient department of Shandong University Qilu hospital during the period of December 1,2017 to February 1,2019 were included.Twenty-nine patients with PD who were admitted to the outpatient department of Shandong Universiity Qilu hospital during the period of December 1,2017 and October 1,2018 were included.Patients in the PSP group were divided into subtypes(PSP-RS and PSP-P groups).Gender,age,course of disease and other relevant information of PSP and PD patients were collected and using MDS-UPDRS(Movement Disorder Society-sponsored Recision of the Unified Parkinson's Disease Rating Scale,MDS-UPDRS)?PSPRS(Progressive Supranuclear Palsy Rating Scale,PSPRS)?MMSE(Mini Mental State Examination,MMSE)?NMSS(Non-Motor Symptoms Scale,NMSS)?IADL(Instrumental Activities of Daily Living Scale,IADL)?ZBI(Zarit Caregiver Burden Interview,ZBI)for scoring.We compared the incidence and severity of non-motor symptoms in PSP and PD groups.Explore the correlation between PSP non-motor symptoms and other clinical features.Use multiple linear regression analysis to evaluate the possible factors affecting daily life ability and caregiver burden.Use SPSS 25.0 software to analyze the collected data.Results1.Demographic characteristics of PSP group and PD groupThere was no statistical difference in gender between PSP and PD groups.The age of patients in the PSP group(mean age 69.24±7.60)was higher than that of PD patients(mean age 64.76±7.08).The duration of disease(median 6 years)in the PD group was longer than that in the PSP group(median 4 years).The PSP group was divided into 15 cases of PSP-RS subtype,9 cases of PSP-P subtype,4 cases of PSP-PGF subtype,and 1 case of PSP-CBS subtype.The duration of disease(median 4 years)in the PSP-P group was longer than that in the PSP-RS group(median 3 years)and there is no significant difference in demographic data such as gender and age.2.Comparison of the incidence of non-motor symptoms between PSP and PDThe most common non-motor symptoms in the PSP group were sleep disturbance/fatigue and mood/apathy,both of which were 96.6%.Next were digestive symptoms(86.2%),urinary symptoms(86.8%)and pain(79.3%).Sexual dysfunction(27.6%)and weight change(17.2%)were less common.The most common symptoms in PD group were also sleep disturbance/fatigue(89.7%),followed by digestive symptoms(86.2%),mood/apathy(72.4%)and attention/memory disorder(72.4%).Mood/apathy,urinary system disorders,pain and increased sweating were more common in PSP group than PD group and the difference was statistically significant.Nocturia was the most common urinary symptom in the PSP group and its incidence was higher than that in PD group.Drooling/dry mouth was more common in PD group while dysphagia/choking(93.1%)was more common in PSP group with significantly difference.3.Comparison of non-motor symptom scale scores in PSP and PD groupThe PSP group scored higher in sleep disorder/fatigue and mood/apathy,followed by attention/memory disorder and digestive symptoms.Weight change and sensory impairment scored the lowest.There was no significant correlation between sleep disorder and urinary system symptoms such as urgency,frequency of urination and increased nocturia in PSP group(P>0.05).The domains with high scores in PD group were sleep disorder/fatigue,mood/apathy,digestive system symptoms and urinary system symptoms.Compared with the PD group,the NMSS scores of PSP group was higher in mood/apathy,gastrointestinal tract disorders and increased sweating which with statistical differences.Other domains were no significant difference in PD and PSP group.4.Comparison of frequency and score of non-motor symptoms between PSP-RS group and PSP-P groupThe most common non-motor symptoms in PSP-RS group were sleep disorder/fatigue and mood/apathy(93.3%)followed by gastrointestinal tract disorders and urinary disorders(86.7%).The incidence of attention/memory disorders was about 66.7%.The incidence of cardiovascular symptoms and impaired taste or olfaction was 53.3%.The most common non-motor symptoms in PSP-P group were sleep disorder/fatigue and mood/apathy,followed by digestive system symptoms(88.9%)and urinary system symptoms(77.8%).The incidence of cardiovascular symptoms,sensory impairment and attention/memory impairment were 66.7%.There was no significant difference in the frequency and scores of non-motor symptoms between PSP-RS and PSP-P groups.5.Correlation between clinical variables in PSP groupNMSS score was positively correlated with PSPRS(r=0.429,P=0.036)and ZBI score(r=0.532,P=0.007)but was not significantly correlated with age of onset,course of disease,IADL score or MMSE.IADL score was significantly negatively correlated with PSPRS score(r=-0.406,P=0.049)and ZBI score(r=-0.406,P=0.049)but was not significantly correlated with other variables.ZBI score was positively correlated with PSPRS score(r=0.534,P=0.007),NMSS score(r=0.441,P=0.0031)and negatively correlated with IADL score(r=-0.406,P=0.049).6.Correlation between clinical variables in PD groupNon-motor symptoms score of PD group was positively correlated with course of disease(r=0.589,P=0.008),total UPDRS score(r=0.714,P=0.001),part ? UPDRS score(r=0.742,P=0.000),part ? UPDRS score(r=0.564,P=0.012),part ? UPDRS score(r=0.650,P=0.003)and ZBI score(r=0.768,P=0.000).It was negatively correlated with MMSE score(r=-0.469,P=0.043)and IADL score(r=-0.637,P=0.003).7.Comparison of clinical variables between PSP and PD groupsThere was no significant difference in MMSE score between PSP and PD.The IADL score of the PSP group was lower than that of the PD group while the ZBI score was higher than that of the PD group with statistically significant differences.8.Multiple linear regression analysis of ZBI and IADL in PSP groupMultiple linear regression analysis showed that PSPRS score(R2=0.379,P=0.001)was the influencing factor of IADL score.NMSS score(R2=0.283,P=0.007)was the influencing factor of ZBI score.9.Multiple linear regression analysis of ZBI and IADL in PD groupPSPRS score(? =-0.615,P=0.001)was the risk factor of IADL score in the PSP group and the fitted linear regression model(R2=0.379,P=0.001)was significant.Both NMSS score(?=0.513,P=0.008)and IADL score(?=-0.425,P=0.022)were influential factors of ZBI score,and the fitted linear regression model(R2=0.666,P=0.000)was significant.ConclusionNon-motor symptoms of PSP are extremely common and some symptoms are even more common and severe than PD.There was no significant difference in the incidence and severity of non-motor symptoms between PSP-RS group and PSP-P group.Severe non-motor symptoms are important reasons for the increased burden on caregivers of PSP patients.