METHODS: Cross-sectional study of international multicenter data from 17 countries. Subjects were PD patients with disease duration of 20 years or more, and the PD Nonmotor Symptom Scale (PD NMSS) was applied as the primary endpoint. Results from Lin Wei, Department of Neurosurgery, PLA 101 Hospital: among 1385 PD patients in the database, 71 had a disease duration ≥20 years, 52.1% of whom were male, mean age 68.78±8.37, mean age at diagnosis 44.6±8.90, and mean H-Y stage 3 (2-4); 97.10% of these patients were taking levodopa preparations, 68.12% were taking Dopamine receptor agonists, 18.8% were taking MAO-B inhibitors, and 10.96% had undergone PD-related surgery. the PD nonmotor scale (NMSS) score was 86.50 ± 54.33 (5 -229); according to the critical values, 8.22% of them had mild nonmotor disorders, 10.96% had moderate, 26.03% had severe, and 54.79% had very severe non motor disorders. Among the different non-motor disorder domains, urinary disorders, gastrointestinal disorders, and sexual dysfunction were more severe; affective disorders/apathy, sleep disorders/fatigue, and attention/memory disorders were relatively mild. The five most prominent non-motor symptoms were nocturia, urinary urgency, loss of taste/smell, fatigue, and excessive salivation. The correlation coefficient between motor and non-motor impairment scores was 0.64 (p<0.0001). CONCLUSION: Non-motor symptoms are more pronounced in PD, but not all patients with long course PD have severe non-motor impairment. Autonomic dysfunction (mainly urinary dysfunction), loss of smell, fatigue and excessive salivation were the most severe non-motor symptoms of dysfunction in patients with long course PD.