Prevalence and duration of non-motor symptoms in prodromal Parkinson's disease.

R Durcan,D J Burn,R A Lawson,G W Duncan,T K Khoo,L Wiblin,D J Brooks,A J Yarnall,N Pavese

doi:10.1111/ene.13919

Abstract

Background and purposeThe prevalence and duration of non‐motor symptoms (NMS) in prodromal Parkinson's disease (PD) has not been extensively studied. The aim of this study was to determine the prevalence and duration of prodromal NMS (pNMS) in a cohort of patients with recently diagnosed PD.MethodsWe evaluated the prevalence and duration of pNMS in patients with early PD (n = 154). NMS were screened for using the Non‐Motor Symptom Questionnaire (NMSQuest). We subtracted the duration of the presence of each individual NMS reported from the duration of the earliest motor symptom. NMS whose duration preceded the duration of motor symptoms were considered a pNMS. Individual pNMS were then grouped into relevant pNMS clusters based on the NMSQuest domains. Motor subtypes were defined as tremor dominant, postural instability gait difficulty (PIGD) and indeterminate type according to the Movement Disorder Society Unified Parkinson's Disease Rating Scale revision.ResultsProdromal NMS were experienced by 90.3% of patients with PD and the median number experienced was 4 (interquartile range, 2–7). A gender difference existed in the pNMS experienced, with males reporting more sexual dysfunction, forgetfulness and dream re‐enactment, whereas females reported more unexplained weight change and anxiety. There was a significant association between any prodromal gastrointestinal symptoms [odds ratio (OR), 2.30; 95% confidence interval (CI), 1.08–4.89, P = 0.03] and urinary symptoms (OR, 2.54; 95% CI, 1.19–5.35, P = 0.016) and the PIGD phenotype. Further analysis revealed that total pNMS were not significantly associated with the PIGD phenotype (OR, 1.10; 95% CI, 0.99–1.21, P = 0.068).ConclusionsProdromal NMS are common and a gender difference in pNMS experienced in prodromal PD may exist. The PIGD phenotype had a higher prevalence of prodromal gastrointestinal and urinary tract symptoms.

Highlights

Parkinson’s disease (PD) has been defined by the presence of motor deficits such as bradykinesia, tremor, rigidity and postural instability [1]
Our study strengthens the notion of non-motor symptoms (NMS) antedating motor symptoms in PD by assessing the presence and time of onset of the full spectrum of prodromal NMS (pNMS) using a validated NMS questionnaire (NMSQuest) in a population with recently diagnosed PD
Interpretation of previous studies evaluating the frequency and duration of onset of pNMS is limited by study methodological variability, lack of direct patient evaluation [2], long duration from PD diagnosis to study enrolment [12], utilization of non-validated, custom-made NMS questionnaires [13] or studying only limited subsets of the spectrum on pNMS in PD cohorts [14] or ‘at risk’ of PD cohorts [15,16]

Summary

Introduction

Parkinson’s disease (PD) has been defined by the presence of motor deficits such as bradykinesia, tremor, rigidity and postural instability [1]. Little is known about the relationship between particular clusters of prodromal NMS (pNMS) and the development of subsequent PD motor phenotypes, i.e. tremor dominant (TD), postural instability gait difficulty (PIGD) or indeterminate type [4]. The prevalence and duration of non-motor symptoms (NMS) in prodromal Parkinson’s disease (PD) has not been extensively studied. Motor subtypes were defined as tremor dominant, postural instability gait difficulty (PIGD) and indeterminate type according to the Movement Disorder Society Unified Parkinson’s Disease Rating Scale revision. The PIGD phenotype had a higher prevalence of prodromal gastrointestinal and urinary tract symptoms

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