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Motor Dysfunction as a Prodrome of Parkinson's Disease

Abstract:

Background: Recognition of motor signs in the prodromal stage could help identify those at risk of developing Parkinson's disease (PD). Objective: This study identified motor symptoms and signs in individuals suspected of having PD but who did not have a progressive reduction in the speed and amplitude of finger tapping or other physical signs indicative of bradykinesia. Methods: 146 patients, who had symptoms or signs suggestive of PD, were serially evaluated by a movement disorder specialist, using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III and video recordings. If the patients 'converted' to PD during follow-up, they were categorized as cases and compared with those who did not meet PD criteria during follow-up (non-cases). Results: The 82 cases were more likely to have action dystonia or postural/action/rest tremor of a limb (OR 2.8; 95% CI 1.1-7.1; p=0.02), a reduced blink rate at rest (OR 2.3; 95% CI 1.2-4.6; p=0.01), anxiety (OR 8.9; 95% CI 2.6-31.1; p<0.001), depression (OR 7.0; 95% CI 2.9-17.2; p<0.001), or a frozen shoulder (OR 3.1; 95% CI 1.6-6.2) than the 64 'non-cases'.A reduction of the fast blink rate was common in patients who met the criteria for PD (p<0.001). Conclusions: This study emphasizes that motor dysfunction is a component of the clinical prodrome seen in some patients with PD.