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Potential impact of self-perceived prodromal symptoms on the early diagnosis of Parkinson’s disease

Journal of Neurology volume 260, pages 3077–3085 (2013)Cite this article

Abstract

The detection of Parkinson’s disease (PD) at stages earlier than current diagnostic criteria allow for may increase the efficacy of disease-modifying therapies. Here we studied the relationship between retrospectively reported prodromal non-motor and motor features of PD, their pre-diagnostic presentation to physicians, and the extrapolated potential of an earlier diagnosis of PD considering early diagnostic markers detected at presence. One hundred and fifteen PD patients (41 women; age 63.2 ± 8.6 years) underwent a structured face-to-face interview on 22 prediagnostic symptoms. Present olfactory function, motor symptoms, and substantia nigra hyperechogenicity (SN-h) were assessed using standardized tools. Most frequently self-perceived symptoms in the early and very early prediagnostic phase (>2, >7 years prior to diagnosis) were hyposmia (23, 10 %), musculoskeletal pain (21, 9 %), and depression/anxiety (14, 11 %). In the late prediagnostic phase (≤2 years) mild motor signs, especially asymmetric bradykinesia and rest tremor, increasingly dominated the self-perception. In the prediagnostic phase, 99 % of patients consulted a physician because of motor symptoms but only 36 % with non-motor symptoms, mostly pain (20 %), depression/anxiety (9 %), constipation, bladder urgency, insomnia, REM sleep behaviour disorder, sexual dysfunction, and malignant melanoma (each, <6 %). Assuming the potential detectability of present hyposmia, asymmetric motor slowing and SN-h, a triad highly specific for PD, as early as 5 years prior to diagnosis, up to 84 (73 %) patients could have been identified in the prediagnostic phase using their or their physicians’ awareness of early symptoms. We conclude that educating the general population and physicians on the importance of distinct prodromal features and applying symptom-specific diagnostic programs can improve the early detection of PD.

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Acknowledgments

The authors wish to thank Mrs. Kerstin Lange und Mrs. Cornelia Berger, technical assistants at the Parkinson Clinic “Waldklinik Bernburg GmbH”, for performing the SS-12 tests.

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Neurology, University of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany

    Uwe Walter, Sabine Kleinschmidt, Florian Rimmele & Reiner Benecke

  2. Parkinson Clinic “Waldklinik Bernburg GmbH”, Bernburg, Germany

    Christian Wunderlich, Irene Gemende & Knut Busse

Authors
  1. Uwe Walter
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  2. Sabine Kleinschmidt
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  3. Florian Rimmele
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  4. Christian Wunderlich
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  5. Irene Gemende
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  6. Reiner Benecke
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  7. Knut Busse
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Correspondence to Uwe Walter.

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S. Kleinschmidt and K. Busse contributed equally.

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Walter, U., Kleinschmidt, S., Rimmele, F. et al. Potential impact of self-perceived prodromal symptoms on the early diagnosis of Parkinson’s disease. J Neurol 260, 3077–3085 (2013). https://doi.org/10.1007/s00415-013-7125-6

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  • DOI: https://doi.org/10.1007/s00415-013-7125-6

Keywords

  • Parkinson’s disease
  • Prodromal phase
  • Hyposmia
  • Pain
  • Substantia nigra hyperechogenicity