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Variation in Recent Onset Parkinson's Disease : Implications for Prodromal Detection

Swallow, Diane M A; Lawton, Michael A; Grosset, Katherine A; Malek, Naveed; Smith, Callum R; Bajaj, Nin P; Barker, Roger A LU ; Ben-Shlomo, Yoav; Burn, David J and Foltynie, Thomas, et al. (2016) In Journal of Parkinson's Disease 6(2). p.289-300
Abstract

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... (More)

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.

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keywords
Journal Article
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Journal of Parkinson's Disease
volume
6
issue
2
pages
12 pages
publisher
IOS Press
external identifiers
  • scopus:84973462703
ISSN
1877-718X
DOI
10.3233/JPD-150741
language
English
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no
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c989a2b9-38ca-4fcb-b316-159404a075ea
date added to LUP
2016-11-23 13:10:39
date last changed
2017-02-19 04:42:46
@article{c989a2b9-38ca-4fcb-b316-159404a075ea,
  abstract     = {<p>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.</p><p>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.</p><p>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 &gt;4), constipation (&lt;1 daily spontaneous bowel motion) and depression (Leeds &gt;6) were recorded in recent onset PD cases, and proposed non-motor screening criteria applied.</p><p>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 &lt; 0.001), more postural instability gait difficulty (PIGD) (p &lt; 0.001), greater cognitive impairment (p &lt; 0.001) and higher total non-motor burden (p &lt; 0.001). Cases with hyposmia alone were younger (p &lt; 0.001), had less severe cognitive (p = 0.006) and other non-motor features (p &lt; 0.001). All screening criteria selected younger patients (p = 0.001, p &lt; 0.001), three of four greater overall non-motor burden (p = 0.005, p &lt; 0.001), and inclusion of RBD more cognitive impairment (p = 0.003, p = 0.001) and PIGD (p = 0.004, p = 0.001).</p><p>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.</p>},
  author       = {Swallow, Diane M A and Lawton, Michael A and Grosset, Katherine A and Malek, Naveed and Smith, Callum R and Bajaj, Nin P and Barker, Roger A and Ben-Shlomo, Yoav and Burn, David J and Foltynie, Thomas and Hardy, John and Morris, Huw R and Williams, Nigel and Wood, Nicholas W and Grosset, Donald G and , },
  issn         = {1877-718X},
  keyword      = {Journal Article},
  language     = {eng},
  month        = {03},
  number       = {2},
  pages        = {289--300},
  publisher    = {IOS Press},
  series       = {Journal of Parkinson's Disease},
  title        = {Variation in Recent Onset Parkinson's Disease : Implications for Prodromal Detection},
  url          = {http://dx.doi.org/10.3233/JPD-150741},
  volume       = {6},
  year         = {2016},
}