{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:30:48Z","timestamp":1790767848748,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,9,27]],"date-time":"2018-09-27T00:00:00Z","timestamp":1538006400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001381","name":"National Research Foundation Singapore","doi-asserted-by":"publisher","award":["TCR12dec010"],"award-info":[{"award-number":["TCR12dec010"]}],"id":[{"id":"10.13039\/501100001381","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>The aim of this study was to examine non\u2010motor symptoms in different Parkinson's disease (<jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>) motor subtypes and their associations with quality of life (QoL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 132 patients with early <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content> with comprehensive motor examinations and non\u2010motor symptom assessments were included. Motor subtypes were classified based on Stebbins\u2019 method. Non\u2010motor symptoms were assessed by the Non\u2010Motor Symptom Scale (<jats:styled-content style=\"fixed-case\">NMSS<\/jats:styled-content>) and validated by more comprehensive instruments, including the Pittsburgh Sleep Quality Index (<jats:styled-content style=\"fixed-case\">PSQI<\/jats:styled-content>) and Fatigue Severity Scale (<jats:styled-content style=\"fixed-case\">FSS<\/jats:styled-content>). QoL was measured by the Parkinson's Disease Questionnaire\u20108.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 66 patients (50%) with tremor\u2010dominant (<jats:styled-content style=\"fixed-case\">TD<\/jats:styled-content>) subtype, 47 (35.6%) with postural instability and gait disorder (<jats:styled-content style=\"fixed-case\">PIGD<\/jats:styled-content>) subtype and 19 (14.4%) with Intermediate subtype. By comparing <jats:styled-content style=\"fixed-case\">NMSS<\/jats:styled-content> scores, patients with the <jats:styled-content style=\"fixed-case\">PIGD<\/jats:styled-content> subtype had more severe sleep impairment and fatigue (domain 2 score: 5.64 vs. 2.52, <jats:italic>P<\/jats:italic> &lt; 0.001), urinary symptoms (domain 7 score: 6.96 vs. 3.48, <jats:italic>P<\/jats:italic> = 0.005) and overall more severe non\u2010motor symptoms (<jats:styled-content style=\"fixed-case\">NMSS<\/jats:styled-content> total score: 25.89 vs. 17.27, <jats:italic>P<\/jats:italic> = 0.031), compared with patients with the <jats:styled-content style=\"fixed-case\">TD<\/jats:styled-content> subtype. Validation using the <jats:styled-content style=\"fixed-case\">PSQI<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">FSS<\/jats:styled-content> again suggested that patients with the <jats:styled-content style=\"fixed-case\">PIGD<\/jats:styled-content> subtype had independently and significantly more severe sleep impairment (<jats:styled-content style=\"fixed-case\">PSQI<\/jats:styled-content> score: 5.57 vs. 4.29, <jats:italic>P<\/jats:italic> = 0.020) and fatigue (<jats:styled-content style=\"fixed-case\">FSS<\/jats:styled-content> score: 34.81 vs. 25.85, <jats:italic>P<\/jats:italic> = 0.003) compared with patients with the <jats:styled-content style=\"fixed-case\">TD<\/jats:styled-content> subtype. Several non\u2010motor symptoms had significant associations with QoL, among which sleep impairment and fatigue (<jats:italic>P<\/jats:italic> &lt; 0.0001, partial <jats:italic>r<\/jats:italic><jats:sup>2<\/jats:sup> = 0.273) explained the largest proportion of QoL variability in patients with <jats:styled-content style=\"fixed-case\">PD<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with the PIGD subtype had more severe sleep impairment, fatigue and urinary disturbance compared with patients with the <jats:styled-content style=\"fixed-case\">TD<\/jats:styled-content> subtype. Sleep impairment and fatigue were the most important factors affecting QoL independent of motor subtypes. Prompt identification and treatment of these non\u2010motor symptoms may improve patients\u2019 QoL.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.13803","type":"journal-article","created":{"date-parts":[[2018,9,3]],"date-time":"2018-09-03T10:21:48Z","timestamp":1535970108000},"page":"400-406","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":74,"title":["Non\u2010motor symptoms in early Parkinson's disease with different motor subtypes and their associations with quality of life"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6695-5606","authenticated-orcid":false,"given":"X.","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Neurology National Neuroscience Institute Singapore"},{"name":"Duke\u2010NUS Graduate Medical School Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Y.\u2010E.","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Neurology National Neuroscience Institute Singapore"},{"name":"Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. S.\u2010Y.","family":"Chia","sequence":"additional","affiliation":[{"name":"Department of Neurology National Neuroscience Institute Singapore"},{"name":"Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Setiawan","sequence":"additional","affiliation":[{"name":"Department of Neurology National Neuroscience Institute Singapore"},{"name":"Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.\u2010Y.","family":"Tay","sequence":"additional","affiliation":[{"name":"Department of Neurology National Neuroscience Institute Singapore"},{"name":"Duke\u2010NUS Graduate Medical School Singapore"},{"name":"Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.\u2010L.","family":"Au","sequence":"additional","affiliation":[{"name":"Department of Neurology National Neuroscience Institute Singapore"},{"name":"Duke\u2010NUS Graduate Medical School Singapore"},{"name":"Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.\u2010K.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Neurology National Neuroscience Institute Singapore"},{"name":"Duke\u2010NUS Graduate Medical School Singapore"},{"name":"Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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