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

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.

Time intervals in diagnosing Parkinson's disease: The patients’ views

“…Health care providers need to recognize the (prodromal) symptoms and suspect PD. The importance of educating physicians to consider the possibility of prodromal PD is already expressed in earlier research [25]. However, communication also seems to be an important factor influencing patients' contentment with their diagnostic pathway [26].…”

“…However, this requires patients who are aware of bodily changes and are capable to carefully monitor their symptoms [19]. In addition, the general population should be more aware of symptoms, that can be highly relevant for the early detection of PD [25].…”

Frequency and profile of Parkinson's disease prodromi in patients with malignant melanoma

“…Colour vision was assessed using the Farnsworth-Munsell 100-Hue test (Torso-Verlag e.K., Wertheim, Germany); age-related 95% percentiles of error scores obtained in a normal population were used as a cut-off value for indicating disturbed colour vision 22. The presence and severity of depression were assessed on the Beck Depression Inventory (depression considered present at a score >13) 7. Constipation was considered to be present in a patient who reported <1 bowel movement/day or in whom the reported symptoms met the Rome diagnostic criteria for constipation.…”

“…The incidence of melanoma has been reported to be increased in PD cases prior to onset of PD compared to non-PD control participants, with an overall OR of about 1.5 1 6 7. This implies an increased risk of PD in individuals with a history of melanoma.…”

“…It is widely accepted that various non-motor and mild motor symptoms may predate the diagnosis of PD 7 12–14. The presence of two or more of the following items asymmetric motor slowing, idiopathic hyposmia and substantia nigra hyperechogenicity (SN+) detected on transcranial sonography has especially been reported as a highly specific diagnostic finding in early PD.…”