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Combined Effects of Depression, Fatigue and Cardiovascular Dysfunction on Functional Dependence Over Seven Years in Early Parkinson's Disease

Lookup NU author(s): Charlotte StewartORCiD, Dr Sahana Sathyanarayana, Victoria Foster, Robyn Iredale, Debra Galley, Dr Jacopo Pasquini, Dr Kirstie Anderson, Professor Nicola PaveseORCiD, Dr David Ledingham

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2025 The Author(s). Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.Background: Parkinson's disease (PD) is associated with both motor and non-motor symptoms, which collectively impact activities of daily living (ADLs) and contribute to the loss of functional independence. There is a lack of understanding of how non-motor symptoms drive this loss in independence. Objectives: This study aims to firstly implement a milestone-based approach to determine the time-points at which subjects with PD require help with specific tasks, using current gold-standard scales. Secondly, we aimed to explore the influence of motor and non-motor symptoms on the progression of functional dependence in individuals with early-stage PD over a 7-year period. Methods: Using data from 166 PD participants, obtained from the Parkinson's Progression Markers Initiative (PPMI), we determined the time taken to reach the first functional dependence “event” over 7 years of annual visits, using clinician- and patient-reported outcomes, including the Schwab & England ADL scale and the MDS-UPDRS Parts I and II. To determine the effect of non-motor symptoms on functional dependence, linear mixed modelling was employed, adjusting for key motor variables, medication, age, sex and PD duration. Results: Depression, fatigue, and motor impairment emerged as significant influencers of functional dependence, with cardiovascular dysfunction nearing significance. Conclusions: We identified that, over time, both motor and non-motor symptoms contributed to the decline in functional independence, with depression, fatigue and cardiovascular dysfunction playing a particularly prominent role. These findings highlight the importance of a comprehensive, multidisciplinary approach to PD management, addressing both motor and non-motor symptoms to improve long-term outcomes and quality of life.

Publication metadata

Author(s): Stewart CB, Sathyanarayana S, Foster VK, Iredale R, Galley D, Pasquini J, Anderson KN, Pavese N, Ledingham D

Publication type: Article

Publication status: Published

Journal: Movement Disorders Clinical Practice

Year: 2025

Volume: 13

Issue: 2

Pages: 399-409

Print publication date: 01/02/2026

Online publication date: 12/09/2025

Acceptance date: 15/07/2025

Date deposited: 30/09/2025

ISSN (electronic): 2330-1619

Publisher: John Wiley and Sons Inc

URL: https://doi.org/10.1002/mdc3.70291

DOI: 10.1002/mdc3.70291

Data Access Statement: The data that support the findings of this study are openly available in m the Parkinson's Progression Markers Initiative database at http://www.ppmi-info.org/access-data-specimens/download-data, reference number RRID:SCR_006431.

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