(P-522) Early Parkinson’s Disease: Association of Baseline Fatigue, Pain and Sleep Disorders with Disease Progression

Background: Non-motor symptoms frequently occur early in Parkinson’s disease. Robust real world data are lacking on the relation of fatigue, pain and sleep disorders in early Parkinson’s disease (ePD) to disease progression. Existing data are based upon small samples from specialty centers or with limited look back time to ensure ePD status. Large populations with Parkinson’s disease (PD) whose medical management is documented through electronic medical records (EMR) may provide new insight into the influence of these symptoms upon PD progression.

Objectives: To determine the association of baseline fatigue, pain and sleep disorders with progression markers within five years after first PD diagnosis.

Methods: A cohort study was constructed using an EMR database. Eligible ePD cases had first PD diagnosis between 1/1/2007 and 3/31/2020 and no PD diagnosis within two years prior. Cases had observation time of 2+ years lookback prior to first PD diagnosis (“index diagnosis”) and no other neurodegenerative diagnosis within 2 years prior nor 3 years after the index diagnosis. Sociodemographic, fatigue, pain and sleep disorders 365 days before index diagnosis were baseline. Fatigue and sleep disorders were obtained from ICD-9 or ICD-10 diagnoses in the EMR. Pain was classified as none or any in the EMR as documented by the patient’s physician. Progression indicators were clinical (dementia, hallucinations, psychosis, repeated falls), advanced therapy initiation (apomorphine, drugs for hallucinations, deep brain stimulation, stomach/intestine tube insertion), or facility admission (hospitalization with primary PD diagnosis, hospitalization with discharge to skilled nursing facility (SNF), or SNF admission) if it occurred beginning 1 day after and within 5 years after index diagnosis. Odds ratios (OR) of progression were computed for fatigue, pain and sleep disorder individually and combinations thereof. Fisher’s exact test, two-tail, assessed statistical significance.

Results: The cohort (n=13,524) had a mean age 73 years, were 57% male, and 83% treatment naive. Fatigue (OR=1.13) and pain (OR=1.34) were significantly (p < 0.05) associated with progression. Sleep disorder was not associated with progression. The combinations of fatigue and pain (OR=1.63), fatigue and sleep disorder (OR=1.26), pain and sleep disorder (OR=1.30), and fatigue, pain and sleep disorder (OR=1.57) were each significantly associated with progression and ORs higher than an individual symptom.

Conclusions: This study demonstrates the impact of non-motor symptoms on PD disease progression. Large cohorts from EMR may be useful for expanding understanding of disease progression.