{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:13:40Z","timestamp":1788416020676,"version":"build-2803163510"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Non-motor symptoms (NMS) are highly prevalent in Parkinson\u2019s disease (PD) and are major determinants of declining quality of life (QoL), yet traditional statistical approaches are insufficient to capture the complex interactions between NMS and QoL. Network analysis offers a promising alternative for exploring these interactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To construct a joint network of non-motor symptoms (NMS) and quality of life (QoL) in patients with Parkinson\u2019s disease (PD), identify core and bridge nodes, and inform precision nursing interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A convenience sample of 342 PD patients was recruited between January and June 2026 from the PD specialty outpatient clinic and neurology inpatient wards of a tertiary specialized hospital in Tianjin, and investigated using the Non-Motor Symptoms Scale (NMSS) and the Parkinson\u2019s Disease Questionnaire-39 (PDQ-39). A joint network model was constructed via network analysis, and network structures were compared between early- and mid-to-late-stage patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      NMSS6 gastrointestinal symptoms (Str\u202f=\u202f1.027), PDQ5 social support (Str\u202f=\u202f0.995), and PDQ6 cognition (Str\u202f=\u202f0.992) were the core nodes of the joint network based on strength centrality. PDQ6 cognition (Bridge Str\u202f=\u202f0.326) and NMSS3 mood\/cognition (Bridge Str\u202f=\u202f0.260) were the key bridge symptoms linking NMS and QoL. Mobility and social support showed the highest expected influence (EI\u202f=\u202f0.960 and 0.939, respectively). The overall network structure differed significantly between early-stage and mid-to-late-stage patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.004), whereas global network strength did not; after correction for multiple comparisons.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Complex associations exist between NMS and QoL in PD patients and are reorganized across disease stages; gastrointestinal symptoms, cognition, and social support represent candidate targets for future longitudinal and interventional research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnagi.2026.1939150","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:23:15Z","timestamp":1788412995000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Joint network analysis of non-motor symptoms and quality of life in patients with Parkinson\u2019s disease"],"prefix":"10.3389","volume":"18","author":[{"given":"CaiNi","family":"Wu","sequence":"first","affiliation":[{"name":"Tianjin University of Traditional Chinese Medicine","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XueYing","family":"Wang","sequence":"additional","affiliation":[{"name":"Tianjin University of Traditional Chinese Medicine","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JiaJia","family":"Li","sequence":"additional","affiliation":[{"name":"Huanhu Hospital Affiliated to Tianjin Medical University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ShaoHua","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Beijing Shijitan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Cong","sequence":"additional","affiliation":[{"name":"Tianjin University of Traditional Chinese Medicine","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Jin","sequence":"additional","affiliation":[{"name":"Discipline Inspection Office of Huanhu Hospital Affiliated to Tianjin Medical University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2284","DOI":"10.1016\/S0140-6736(21)00218-X","article-title":"Parkinson's disease","volume":"397","author":"Bloem","year":"2021","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e2194","DOI":"10.1212\/WNL.0000000000200113","article-title":"Association of Motor and Nonmotor Symptoms with Health-Related Quality of life in a large online cohort of people with Parkinson disease","volume":"98","author":"Bock","year":"2022","journal-title":"Neurology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1037\/abn0000446","article-title":"What do centrality measures measure in psychological networks?","volume":"128","author":"Bringmann","year":"2019","journal-title":"J. Abnorm. Psychol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2069","DOI":"10.3390\/jcm13072069","article-title":"Predicting depression in Parkinson's disease using commonly available PD questionnaires","volume":"13","author":"Camerucci","year":"2024","journal-title":"J. Clin. Med."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1186\/s12877-022-03612-4","article-title":"Exploring factors that influence HRQoL for people living with Parkinson's in one region of Ireland: a cross-sectional study","volume":"22","author":"Cassidy","year":"2022","journal-title":"BMC Geriatr."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1002\/mds.21596","article-title":"The metric properties of a novel non-motor symptoms scale for Parkinson's disease: results from an international pilot study","volume":"22","author":"Chaudhuri","year":"2007","journal-title":"Mov. Disord."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s12889-024-21236-8","article-title":"Exploring the stigma experienced by people affected by Parkinson's disease: a systematic review","volume":"25","author":"Crooks","year":"2025","journal-title":"BMC Public Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"101","DOI":"10.2147\/DNND.S535306","article-title":"Symptom networks and associations with quality of life in patients with early to mid-stage Parkinson's disease: a network analysis","volume":"15","author":"Deng","year":"2025","journal-title":"Degener Neurol Neuromuscul Dis"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"195","DOI":"10.3758\/s13428-017-0862-1","article-title":"Estimating psychological networks and their accuracy: a tutorial paper","volume":"50","author":"Epskamp","year":"2018","journal-title":"Behav. Res. Methods"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1679","DOI":"10.1002\/mds.29507","article-title":"Adjusting for underrepresentation reveals widespread underestimation of Parkinson's disease symptom burden","volume":"38","author":"Hamedani","year":"2023","journal-title":"Mov. Disord."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"972210","DOI":"10.3389\/fneur.2023.972210","article-title":"Longitudinal analysis of the non-motor symptoms scale in Parkinson's disease (NMSS): an exploratory network analysis approach","volume":"14","author":"Heimrich","year":"","journal-title":"Front. Neurol."},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12072573","article-title":"The impact of nonmotor symptoms on health-related quality of life in Parkinson's disease: a network analysis approach","volume":"12","author":"Heimrich","year":"","journal-title":"J. Clin. Med."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1080\/00273171.2019.1614898","article-title":"Bridge centrality: a network approach to understanding comorbidity","volume":"56","author":"Jones","year":"2021","journal-title":"Multivariate Behav Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.parkreldis.2019.05.009","article-title":"Predictors of health-related quality of life in Parkinson's disease","volume":"65","author":"Kuhlman","year":"2019","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"909","DOI":"10.4103\/aian.aian_647_21","article-title":"Assessment of non-motor symptoms of Parkinson's disease and their impact on the quality of life: an Observatiobnal study","volume":"25","author":"Kumar","year":"2022","journal-title":"Ann. Indian Acad. Neurol."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1159\/000543457","article-title":"Effects of meditation and yoga on anxiety, depression and chronic inflammation in patients with Parkinson's disease: a randomized clinical trial","volume":"94","author":"Kwok","year":"2025","journal-title":"Psychother. Psychosom."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"101834","DOI":"10.1016\/j.arr.2022.101834","article-title":"Premotor, nonmotor and motor symptoms of Parkinson's disease: a new clinical state of the art","volume":"84","author":"Leite Silva","year":"2023","journal-title":"Ageing Res. Rev."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1007\/s00415-020-09723-5","article-title":"Gastrointestinal dysfunction in Parkinson's disease","volume":"267","author":"Lubomski","year":"2020","journal-title":"J. Neurol."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1631\/jzus.B0900380","article-title":"Validity and reliability testing of the Chinese (mainland) version of the 39-item Parkinson's disease questionnaire (PDQ-39)","volume":"11","author":"Luo","year":"2010","journal-title":"J. Zhejiang Univ. Sci. B"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.2147\/CIA.S516786","article-title":"An interdisciplinary approach to assistive technology for Parkinson's disease dementia","volume":"20","author":"Munzesheimer","year":"2025","journal-title":"Clin. Interv. Aging"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"101665","DOI":"10.1016\/j.arr.2022.101665","article-title":"The association between Parkinson's disease and sexual dysfunction: clinical correlation and therapeutic implications","volume":"79","author":"Ng","year":"2022","journal-title":"Ageing Res. Rev."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1038\/s41582-025-01163-x","article-title":"Characteristics and mechanisms of cognitive impairment in Parkinson disease","volume":"22","author":"Oikonomou","year":"2026","journal-title":"Nat. Rev. Neurol."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2258","DOI":"10.1038\/s41598-018-36973-1","article-title":"Network analysis of the multidimensional symptom experience of oncology","volume":"9","author":"Papachristou","year":"2019","journal-title":"Sci. Rep."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"268","DOI":"10.3760\/cma.j.issn.1006-7876.2016.04.002","article-title":"Diagnostic criteria for Parkinson\u2019s disease in China [J]","volume":"49","year":"2016","journal-title":"Chin J Neurol,"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"379","DOI":"10.3233\/JPD-225073","article-title":"Staging Parkinson's disease according to the MNCD (motor\/non-motor\/cognition\/dependency) classification correlates with disease severity and quality of life","volume":"13","author":"Santos-Garc\u00eda","year":"2023","journal-title":"J. Parkinsons Dis."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"7221","DOI":"10.1038\/s41598-023-34412-4","article-title":"Using network analysis to explore the validity and influential items of the Parkinson's disease Questionnaire-39","volume":"13","author":"Sch\u00f6nenberg","year":"2023","journal-title":"Sci. Rep."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2510","DOI":"10.14309\/ajg.0000000000003508","article-title":"Parkinson disease and the gut: a primer for gastroenterologists","volume":"120","author":"Sharma","year":"2025","journal-title":"Am. J. Gastroenterol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1016\/S1474-4422(23)00109-6","article-title":"Assessment of heterogeneity among participants in the Parkinson's progression markers initiative cohort using \u03b1-synuclein seed amplification: a cross-sectional study","volume":"22","author":"Siderowf","year":"2023","journal-title":"Lancet Neurol."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1038\/s41386-019-0448-y","article-title":"Sleep in Parkinson's disease","volume":"45","author":"Stefani","year":"2020","journal-title":"Neuropsychopharmacology"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1016\/j.clineuro.2009.02.005","article-title":"Validation of the Chinese non-motor symptoms scale for Parkinson's disease: results from a Chinese pilot study","volume":"111","author":"Wang","year":"2009","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2895","DOI":"10.12114\/j.issn.1007\u20119572.2025.0319","article-title":"Analysis of the disease burden of Parkinson's disease in China and globally from 1990 to 2021 and prediction of future trends","volume":"29","author":"Wu","year":"2026","journal-title":"Chinese General Practice"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3870\/j.issn.1001-4152.2022.05.091","article-title":"A review of network approach in symptom management","volume":"37","author":"Yang","year":"2022","journal-title":"J. Nurs. Sci."}],"container-title":["Frontiers in Aging Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2026.1939150\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:23:18Z","timestamp":1788412998000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2026.1939150\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":32,"alternative-id":["10.3389\/fnagi.2026.1939150"],"URL":"https:\/\/doi.org\/10.3389\/fnagi.2026.1939150","relation":{},"ISSN":["1663-4365"],"issn-type":[{"value":"1663-4365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1939150"}}