Variation in recent onset Parkinson's Disease: implications for prodromal detection

Diane M A Swallow, Michael A Lawton, Katherine A Grosset, Naveed Malek, Callum R Smith, Nin P Bajaj, Roger A Barker, Yoav Ben-Shlomo, David J Burn, Thomas Foltynie, John Hardy, Huw R Morris, Nigel Williams, Nicholas W Wood, Donald G Grosset, PRoBaND Clinical Consortium

Research output: Contribution to journalArticle (Academic Journal)peer-review

18 Citations (Scopus)
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BACKGROUND: The detection of prodromal Parkinson's disease (PD) is desirable to test drugs with neuroprotective potential, but will be affected by known disease variations.

OBJECTIVE: To assess the prevalence of four key non-motor prodromal PD markers, and evaluate the sensitivity of case detection when non-motor screening tools for prodromal PD are implemented in an early clinical PD cohort.

METHODS: Hyposmia (University of Pennsylvania smell identification test ≤15th centile or Sniffin' Sticks at or ≤10th centile corrected for age and sex), rapid-eye movement sleep behaviour disorder (RBD questionnaire >4), constipation (<1 daily spontaneous bowel motion) and depression (Leeds >6) were recorded in recent onset PD cases, and proposed non-motor screening criteria applied.

RESULTS: In 1,719 PD cases, mean age 68.6 years (SD 8.1), 65.5% male, mean disease duration 1.3 years (SD 0.9), 72.2% were hyposmic, 43.3% had RBD, 22.1% depression, and 21.5% constipation. 11.6% of cases had no key non-motor features, 38.8% one, 32.1% two, 15.5% three, and 2.0% all four. Increasing numbers of non-motor features were associated with younger age (p = 0.019), higher motor scores (p <  0.001), more postural instability gait difficulty (PIGD) (p <  0.001), greater cognitive impairment (p <  0.001) and higher total non-motor burden (p <  0.001). Cases with hyposmia alone were younger (p <  0.001), had less severe cognitive (p = 0.006) and other non-motor features (p <  0.001). All screening criteria selected younger patients (p = 0.001, p <  0.001), three of four greater overall non-motor burden (p = 0.005, p <  0.001), and inclusion of RBD more cognitive impairment (p = 0.003, p = 0.001) and PIGD (p = 0.004, p = 0.001).

CONCLUSIONS: Varying sensitivity levels, and age and phenotype selectivity, are found when different non-motor screening methods to detect prodromal PD are applied to an early clinical PD cohort.

Original languageEnglish
Pages (from-to)289-300
Number of pages12
JournalJournal of Parkinson's Disease
Issue number2
Publication statusPublished - 26 May 2016


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