Identification of Prodromal Presentations of Parkinson’s Disease among Primary Care Outpatients in Germany

Abstract

Background: This study aimed to identify clinical features that predate the diagnosis of PD in a primary care setting. Methods: This retrospective case-control study was based on data from the Disease Analyzer database (IQVIA) and included 17,702 patients with Parkinson’s disease and 17,702 non-PD controls matched for age, sex, and index year. We analyzed the prevalence of 15 defined diagnoses and symptoms documented within 2 years, ≥2 to <5, and ≥5 to <10 years prior to the index date in patients with and without PD. Logistic regression analyses were conducted to assess the association between PD and the predefined diagnoses. Results: The prevalence of motor, neuropsychiatric and autonomic features was higher in those with a later diagnosis of Parkinson’s disease than controls for all three periods except for rigidity in the ≥2 to <5 and ≥5 to <10-year periods and erectile dysfunction in the most recent period before diagnosis. The clinical presentation recorded in the greatest percentage of patients was depression, followed by dizziness, insomnia, and constipation, but these were also common in the control population. The odds ratios were highest for increase in tremor, followed by balance impairment and memory problems, particularly in the latest period before diagnosis, and by constipation particularly in the earliest period examined. Conclusion: The prodromal features of PD could be identified in this large primary care database in Germany with similar results to those found in previous database studies despite differences in methodologies and systems.

Pre-diagnostic presentations of Multiple System Atrophy case control study in a primary care dataset

“…These findings confirm the prominent autonomic involvement in the early stages of MSA, including postural hypotension, constipation, and urinary dysfunction, with early and prominent balance problems and a proportion who have ataxia. Compared to our results in Parkinson's disease study in the same database (11), the differences in the ORs regarding hypotension (OR 15.69 vs 2.28), balance impairments (OR 11.23 vs 3.47), and urinary dysfunction (OR 4.49 vs 2.64) in the 2 years before diagnosis are particularly noticeable.…”

“…A pattern of initial genitourinary dysfunction followed by orthostatic hypotension and sleep disorders including RBD and sleep apnoea, and respiratory disturbances including excessive snoring and stridor has been suggested [4,6]). Olfactory loss and cognitive impairment [3,6,8,9] on the other hand have been suggested to be relatively rare in the early phase of MSA, unlike in PD where these are reported to be early complaints [10,11].…”

Assessment of Risk Factors and Early Presentations of Parkinson Disease in Primary Care in a Diverse UK Population

“…Various studies have reported that tremor may be an early feature of PD. 9,[32][33][34] In people reporting tremor years before diagnosis, one must consider the possibility that diagnosis is simply delayed in primary care. That is, individuals seeing general practitioners may not be referred early enough to a movement disorders specialist.…”

Widening the Spectrum of Risk Factors, Comorbidities, and Prodromal Features of Parkinson Disease

“…This extends and confirms our previously reported analysis of some of the included risk factors and prodromal features of PD in the German specialist practices. 2 This study also had limitations, as it relied on diagnosis of PD using patient medical records, and application of diagnostic criteria was not possible. Although other electronic health care databases, such as The Health Improvement Network in the UK, have shown acceptable accuracy of primary care diagnosis of PD using a single diagnostic code, 1 albeit with slightly higher incidence rates, 72 no validation study is available in this data source.…”

“…rodromal features of Parkinson disease (PD) can start more than a decade before the typical clinical symptoms allow a diagnosis. 1,2 In addition, there is increasing evidence for a number of possible risk factors that may predispose to the manifestation of the disease or facilitate development or spread of pathological lesions. These risk factors include well-known genetic or environmental risk factors but also diabetes type 2 or gastric pathology, which may increase spread of pathology from the enteric nervous system via the vagal nerve to the central nervous system.…”