Premotor Parkinson's disease: Overview of clinical symptoms and current diagnostic methods

Abstract

Parkinson's disease (PD) is characterized by typical motor symptoms. However, recent studies show several non-motor features that may precede the development of the motor symptoms of PD. The best known premotor symptoms include hyposmia, REM sleep behavior disorder (RBD), constipation, and depression; other symptoms are excessive daytime somnolence, orthostatic hypotension and symptomatic hypotension, erectile or urinary dysfunction, musculoskeletal symptoms, pain, and global cognitive deficit. In this review, we summarize currently available diagnostic methods for these symptoms. We also briefly summarize neuroimaging, polyneuropathy, peripheral markers, and cerebrospinal fluid biomarkers that may be used in the early diagnosis of PD.

Pharmacological and Non-pharmacological Treatments of Sleep Disorders in Parkinson's Disease

“…Only 1% of adults had RBD, but this number for PD patients ranged from 30.0 to 62.5% [ 2 ]. RBD can appear before or after the development of motor symptoms of PD [ 87 ]. Prospective clinical studies have suggested that PD patients with RBD were disabled earlier than those without RBD.…”

“…EDS, especially the sudden sleep attacks, posed a great risk on PD patients' daily lives when driving cars or operating machines, which limited their activities to a very small life circle and significantly increased disease burden [ 85 ]. Some studies believe that EDS is a potential risk factor leading to the deterioration of PD [ 87 ] Dhawan et al . found EDS was much worse in drug-naive PD patients compared to healthy controls, and became even worse in advanced PD [ 119 ].…”

Parkinson's disease: the nutrition perspective

“…Macmahon and Thomas proposed a scale to describe the clinical course of PD from the ‘diagnostic’ phase; through a relatively stable ‘maintenance’ phase; progressing to a ‘complex’ phase, characterised by motor fluctuations, development of cognitive impairment and appearance of axial symptoms, including falls, freezing of gait and dysphagia; finally reaching a palliative phase (8) . It is now recognised that several symptoms, in particular rapid-eye-movement sleep behaviour disorder, constipation, anosmia and depression, known as premotor symptoms, may precede the onset of motor symptoms by many years, during what is referred to as the ‘prodromal’ phase (9,10) .…”