SELF-REPORTED EARLIEST SYMPTOMS OF PARKINSON DISEASE.

Abstract

Purpose/Hypothesis: Parkinson disease (PD) is caused by cell death in the substantia nigra pars compacta of the midbrain. Although the classic diagnostic signs of PD are muscle rigidity, tremor, and bradykinesia, these signs only appear after approximately 90% of the neurons within the pars compacta have degenerated. Currently, research is focused on developing neuroprotective treatments to halt the progression of cell death in PD. Neuroprotective treatments will only be effective if the cell death can be recognized by signs that precede the cardinal signs of PD. Physical therapists, trained to observe movement, are well-suited to develop early detection tests for PD. The purpose of this study was to ask persons with PD directly about their earliest symptoms, to obtain clues for early detection. To date, no one has methodically queried persons with the disease about pre-diagnostic symptoms. Number of Subjects: 45. Materials/Methods: Surveys were distributed at support groups, physician offices, and on an internet website, and were completed anonymously by persons with idio-pathic PD. The survey included basic demographic data, multiple-choice questions, and open-ended questions related to pre-diagnostic physical and emotional symptoms. Subjects were required to order the onset of symptoms in each section. Results: Forty-five people (16 females, 29 males, aged 73.2 ± 8.9) responded to the survey. The average number of years with PD was 8 ± 6.53. Thirty-five percent of respondents reported tremor as the first sign of PD. The remaining subjects reported diminished olfaction, depression, voice changes, and bradykinesia. An analysis of all early signs revealed that 1) as a cluster of early symptoms, sleep disorders, fatigue, depression and tiredness occurred in 50% of subjects, and 2) males and females had different early signs: males more often reported classic signs of the disease, and females more often reported fatigue, tiredness, depression and voice-weakening. Ten-percent of all subjects also reported that symptoms first appeared after major medical events, such as surgery or trauma. Conclusions: This study had 2 major findings. First, most people with PD reported a classic symptom as the first symptom of PD, suggesting that they were unable to detect any subtle earlier symptoms of impending PD. Second, females especially, reported fatigue, depression, tiredness and sleep disturbances as early signs of PD. This cluster of symptoms should be added to previously reported micrographia and diminished olfaction, as early indicators of PD. Clinical Relevance: Because individuals may not be able to detect the early symptoms of PD, physical therapists should be aware that pre-diagnostic signs of PD may include fatigue, depression, tiredness, and sleep disturbances, in addition to the previously reported micrographia and diminished olfaction. In addition, physical therapists need to conduct more research to develop clinical test batteries for early detection. The ultimate goal would be to halt disease progression with new neuroprotective treatments, such as drug, gene, or physical therapy.