Objective: To conduct a 20-year review of the movement disorders (MD) clinical database in Singapore.

Background: MDs contribute to a significant portion of chronic disease burden globally, with close to 1.08 million newly diagnosed patients with Parkinson’s disease (PD) and 8.51 million existing PD patients in 2019.

Method: 9010 patients were recruited between 2002 to 2022. These were split into four 5-year periods: (PA) Year 2002-2006, (PB) 2007-2011, (PC) 2012-2016, and (PD) 2017-2022. Demographics, symptoms, diagnoses and comorbidities were recorded and updated at every visit. Kruskal-Wallis was done to compare the differences between the four periods to establish the disease incidence, with post-hoc analysis done using Mann-Whitney U.

Results: Parkinsonism (51.99%), tremor disorders (14.73%) and hemi-facial spasms (9.36%) had the highest incidence rates in newly diagnosed MDs, with males comprising 57.45%, 57.48% and 41.0% of these cases respectively.  The mean age at diagnosis were years 65.7 in parkinsonism, 52.7 in tremor disorders and 53.3 in hemi-facial spasms. 

Accounting for 95.8% of Parkinsonism, the most common diagnoses were PD (n=3986), atypical Parkinsonism (n=260) and vascular Parkinsonism (n=252). Essential tremors (n=1114), enhanced physiological tremors (n=170) and primary handwriting tremors (n=25) made up 98.6% of all tremor disorder cases. 

In the first three periods, increased incidence of Parkinsonism was reported with 867 cases in PA, 1213 in PB and 1331 in PC. However, the incidence rate dropped to 627 in PD. Mean H&Y scores at diagnosis were 2.76 for PA, 2.73 for PB, 2.30 for PC and 2.21 for PD, with significant difference found between these groups (χ2(3)=46.298, p<.001). Post-hoc analysis revealed significant differences between PA and PC (U=8999.50, p<.001), PA and PD (U=4928.00, p<.001), PB and PC (U=34716.00, p<.001), PB and PD (U=19024.00, p<.001), and PC and PD (U=193286.50, p<.05).

Conclusion: The steady increase in Parkinsonism incidence rates across PA to PC may be due to increased public education and aging population. The steep decline in PD may be attributed by possible under-reporting during the pandemic as non-emergent cases were deferred to minimize community transmission. The full impact of COVID-19 on MD disease burden has yet to be elucidated. Additionally, patients with Parkinsonism symptoms appear to be seeking medical attention in the early stages.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-20-year-review-of-a-movement-disorders-database-in-singapore/