Research Article| Volume 66, P151-157, September 2019

Download started.


Non-motor symptoms burden, mood, and gait problems are the most significant factors contributing to a poor quality of life in non-demented Parkinson's disease patients: Results from the COPPADIS Study Cohort


      • Non-motor symptoms (NMS) are frequent in Parkinson's disease (PD) patients during the first steps of the disease.
      • Health-related and global perceived quality of life (QoL) are worse in PD patients than controls.
      • Strong correlation was observed between PQ-10 and EUROHIS-QOL8, both scales to provide global QoL.
      • NMS burden, mood, and gait problems are the most significant factors contributing to a worse QoL.
      • In practice, it is necessary to ask about NMS, mood, and gait problems in PD patients during their first years of evolution.



      To identify factors related to a poor health-related and global quality of life (QoL) in a cohort of non-demented Parkinson's disease (PD) patients and compare to a control group.


      The data correspond to the baseline evaluation of the COPPADIS-2015 Study, an observational, 5-year follow-up, multicenter, evaluation study. Three instruments were used to assess QoL: (1) the 39-item Parkinson's disease Questionnaire (PDQ-39), (2) a subjective rating of global QoL (PQ-10), and (3) the EUROHIS-QOL 8-item index (EUROHIS-QOL8). Multiple linear regression methods were used to evaluate the direct impact of different variables on these QoL measures.


      QoL was worse in PD patients (n = 692; 62.6 ± 8.9 years old, 60.3% males) than controls (n = 206; 61 ± 8.3 years old, 49.5% males): PDQ-39, 17.1 ± 13.5 vs 4.4 ± 6.3 (p < 0.0001); PQ-10, 7.3 ± 1.6 vs 8.1 ± 1.2 (p < 0.0001); EUROHIS-QOL8, 3.8 ± 0.6 vs 4.2 ± 0.5 (p < 0.0001). A high correlation was observed between PDQ-39 and Non-Motor Symptoms Scale (NMSS) (r = 0.72; p < 0.0001), and PDQ-39 and Beck Depression Inventory-II (BDI-II) (r = 0.65; p < 0.0001). For health-related QoL (PDQ-39), non-motor symptoms burden (NMSS), mood (BDI-II), and gait problems (Freezing Of Gait Questionnaire [FOGQ]) provided the highest contribution to the model (β = 0.32, 0.28, and 0.27, respectively; p < 0.0001); whereas mood and gait problems contributed the most to global QoL (PQ-10, β = -0.46 and −0.21, respectively; EUROHIS-QOL8, β = -0.44 and −0.23, respectively).


      QoL is worse in PD patients than in controls. Mood, non-motor symptoms burden, and gait problems seem to be the most relevant factors affecting health-related and global perceived QoL in non-demented PD patients.



      ADLS (Schwab & England Activities of Daily Living Scale), BDI, (Beck Depression Inventory-II), EUROHIS-QOL8 (European Health Interview Survey-Quality of Life 8 Item-Index), FOG (freezing of gait), FOGQ (freezing of gait Questionnaire), GQoL (Global quality of life), HRQoL (health-related quality of life), H&Y (Hoenh & Yahr), NMS (non-motor symptoms), NMSS (Non-Motor Symptoms Scale), NPI (Neuropsychiatric Inventory), PD (Parkinson's disease), PD-CRS (Parkinson's Disease Cognitive Rating Scale), PDQ-39SI (39-item Parkinson's Disease Quality of Life Questionnaire Summary Index), PDSS (Parkinson's Disease Sleep Scale), QoL (Quality of life), QUIP-RS (Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale), UPDRS (Unified Parkinson's Disease Rating Scale), VAFS (Visual Analog Fatigue Scale), VAS-Pain (Visual Analog Scale-Pain)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Parkinsonism & Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Chaudhuri K.R.
        • Prieto-Jurcynska C.
        • Naidu Y.
        • Mitra T.
        • Frades-Payo B.
        • Tluk S.
        • et al.
        The nondeclaration of nonmotor symptoms of Parkinson's disease to health care professionals: an international study using the nonmotor symptoms questionnaire.
        Mov. Disord. 2010; 25: 704-709
        • Martinez-Martin P.
        • Rodriguez-Blazquez C.
        • Kurtis M.M.
        • Chaudhuri K.R.
        • NMSS Validation Group
        The impact of non-motor symptoms on health-related quality of life of patients with Parkinson's disease.
        Mov. Disord. 2011; 26: 399-406
        • Schapira A.H.V.
        • Chaudhuri K.R.
        • Jenner P.
        Non-motor features of Parkinson's disease.
        Nat. Rev. Neurosci. 2017; 18: 435-450
        • Martinez-Martin P.
        • Kurtis M.M.
        Health-related quality of life as an outcome variable in Parkinson's disease.
        Ther Adv Neurol Disord. 2012; 5: 105-117
        • Martinez-Martin P.
        • Rodriguez-Blazquez C.
        • Abe K.
        • Bhattacharyya K.B.
        • Bloem B.R.
        • Carod-Artal F.J.
        • et al.
        International study on the psychometric attributes of the non-motor symptoms scale in Parkinson disease.
        Neurology. 2009; 73: 1584-1591
        • Krishnan S.
        • Sarma G.
        • Sarma S.
        • Kishore A.
        Do nonmotor symptoms in Parkinson's disease differ from normal aging?.
        Mov. Disord. 2011; 26: 2110-2113
        • Hinnell C.
        • Hurt C.S.
        • Landau S.
        • Brown R.G.
        • Samuel M.
        • PROMS-PD Study Group
        Nonmotor versus motor symptoms: how much do they matter to health status in Parkinson's disease?.
        Mov. Disord. 2012; 27: 236-241
        • Schrag A.
        • Jahanshahi M.
        • Quinn N.
        What contributes to quality of life in patients with Parkinson's disease?.
        J. Neurol. Neurosurg. Psychiatry. 2000; 69: 308-312
        • Kuopio A.M.
        • Marttila R.J.
        • Helenius H.
        • Toivonen M.
        • Rinne U.K.
        The quality of life in Parkinson's disease.
        Mov. Disord. 2000; 15: 216-223
        • Muslimovic D.
        • Post B.
        • Speelman J.D.
        • Schmand B.
        • de Haan R.J.
        Determinants of disability and quality of life in mild to moderate Parkinson disease.
        Neurology. 2008; 70: 2241-2247
        • Behari M.
        • Srivastava A.K.
        • Pandey R.M.
        Quality of life in patients with Parkinson's disease.
        Park. Relat. Disord. 2005; 11: 221-226
        • Karlsen K.H.
        • Larsen J.P.
        • Tandberg E.
        • Maland J.G.
        Quality of life measurements in patients with Parkinson's disease: a communitybased study.
        Eur. J. Neurol. 1998; 5: 443-450
        • Rahman S.
        • Griffin H.J.
        • Quinn N.P.
        • Jahanshahi M.
        Quality of life in Parkinson's disease: the relative importance of the symptoms.
        Mov. Disord. 2008; 23: 1428-1434
        • Slawek J.
        • Derejko M.
        • Lass P.
        Factors affecting the quality of life of patients with idiopathic Parkinson's disease-a cross-sectional study in an outpatient clinic attendees.
        Park. Relat. Disord. 2005; 11: 465-468
        • Chapuis S.
        • Ouchchane L.
        • Metz O.
        • Gerbaud L.
        • Durif F.
        Impact of the motor complications of Parkinson's disease on the quality of life.
        Mov. Disord. 2005; 20: 224-230
        • Karlsen K.H.
        • Larsen J.P.
        • Tandberg E.
        • Maeland J.G.
        Influence of clinical and demographic variables on quality of life in patients with Parkinson's disease.
        J. Neurol. Neurosurg. Psychiatry. 1999; 66: 431-435
        • Santos-García D.
        • Mir P.
        • Cubo E.
        • Vela L.
        • Rodríguez-Oroz M.C.
        • Martí M.J.
        • Arbelo J.M.
        • et al.
        • COPPADIS Study Group
        COPPADIS-2015 (COhort of Patients with Parkinson's DIsease in Spain, 2015), a global--clinical evaluations, serum biomarkers, genetic studies and neuroimaging--prospective, multicenter, non-interventional, long-term study on Parkinson's disease progression.
        BMC Neurol. 2016 Feb 25; 16: 26
        • Kalia L.V.
        • Lang A.E.
        Parkinson's Disease.
        Lancet. 2015; 386: 896-912
        • Jenkinson C.
        • Fitzpatrick R.
        • Peto V.
        • Greenhall R.
        • Hyman N.
        The Parkinson's Disease Questionnaire (PDQ-39): development and validation of a Parkinson's disease summary index score.
        Age Ageing. 1997; 26: 353-357
        • Santos García D.
        • de la Fuente-Fernández R.
        Impact of non-motor symptoms on health-related and perceived quality of life in Parkinson's disease.
        J. Neurol. Sci. 2013; 332: 136-140
        • Da Rocha N.S.
        • Power M.J.
        • Bushnell D.M.
        • Fleck M.P.
        The EUROHIS-QOL 8-item index: comparative psychometric properties to its parent WHOQOL-BREF.
        Value Health. 2012; 15: 449-457
        • Ray Chaudhuri K.
        • Rojo J.M.
        • Schapira A.H.
        • Brooks D.J.
        • Stocchi F.
        • Odin P.
        • et al.
        A proposal for a comprehensive grading of Parkinson's disease severity combining motor and non-motor assessments: meeting an unmet need.
        PLoS One. 2013; 8e57221
      1. The EUROHIS-QOL 8-item index: psychometric results of a cross-cultural field study. Schmidt S, Mühlan H, Power M.
        Eur. J. Public Health. 2006; 16: 420-428
        • Chaudhuri K.R.
        • Martinez-Martin P.
        • Brown R.G.
        • Sethi K.
        • Stocchi F.
        • Odin P.
        • et al.
        The metric properties of a novel non-motor symptoms scale for Parkinson's disease: results from an international pilot study.
        Mov. Disord. 2007; 22: 1901-1911
        • Skorvanek M.
        • Martinez-Martin P.
        • Kovacs N.
        • Zezula I.
        • Rodriguez-Violante M.
        • Corvol J.C.
        • et al.
        Relationship between the MDS-UPDRS and Quality of Life: a large multicenter study of 3206 patients.
        Park. Relat. Disord. 2018; 52: 83-89
        • Wu Y.
        • Guo X.Y.
        • Wei Q.Q.
        • Ou R.W.
        • Song W.
        • Cao B.
        • Zhao B.
        • Shang H.F.
        Non-motor symptoms and quality of life in tremor dominant vs postural instability gait disorder Parkinson's disease patients.
        Acta Neurol. Scand. 2016; 133: 330-337
        • Heller J.
        • Dogan I.
        • Schulz J.B.
        • Reetz K.
        Evidence for gender differences in cognition, emotion and quality of life in Parkinson's disease?.
        Aging Dis. 2013; 5: 63-75
        • Walton C.C.
        • Shine J.M.
        • Hall J.M.
        • O'Callaghan C.
        • Mowszowski L.
        • Gilat M.
        • et al.
        The major impact of freezing of gait on quality of life in Parkinson's disease.
        J. Neurol. 2015; 262: 108-115
        • Moore O.
        • Peretz C.
        • Giladi N.
        Freezing of gait affects quality of life of peoples with Parkinson's disease beyond its relationships with mobility and gait.
        Mov. Disord. 2007; 22: 2192-2195
        • Perez-Lloret S.
        • Negre-Pages L.
        • Damier P.
        • Delval A.
        • Derkinderen P.
        • Destée A.
        • et al.
        Prevalence, determinants, and effect on quality of life of freezing of gait in Parkinson disease.
        JAMA Neurol. 2014; 71: 884-890