Objective: To determine the differences in motor and non-motor symptoms between subjects categorized as Low, Intermediate, or High Risk for future Parkinson’s Disease (PD).

Background: Prodromal PD symptoms have been well understood through several algorithmic tools. However, majority of the tools were derived from Western cohorts, with limited validation in Asian populations. By refining our understanding of prodromal PD, it would enable early identification of PD in Asians. To the best of our knowledge, ours is the first study to investigate the differences in non-motor and motor symptoms in subjects with varying risk for PD.

Method: Subjects were recruited from either the National Neuroscience Institute’s Sleep Disorder Clinic or the community. Demographic, cognitive, non-motor, motor, imaging assessments and Polysomnography (PSG) were conducted. The data was used to derive the Likelihood Ratio (LR) using the MDS prodromal PD criteria.

Subjects were categorized into 3 groups: (1) High Risk: PSG confirmed RBD, (2) Intermediate Risk using either by LR >30% or hyposmia determined by the lowest 15^th percentile based on age and sex and (3) Low Risk without RBD and prodromal markers.

Results: 345 subjects enrolled (M=52.75%; 64.24±8.58 years). 17 subjects were High Risk (M=76.47%; 64.88±5.70 years), 69 subjects were Intermediate Risk (M=46.38%; 65.41±5.24 years) and 259 subjects were Low Risk (M=52.90%; 63.89±9.40 years). 

Intermediate Risk subjects had significantly higher MDS-UPDRS-I scores than the Low-Risk group (p = 2.2 × 10⁻⁵). The High-Risk group had significantly higher MDS-NMS scores than the Intermediate-Risk group (p = 0.0079) and with the Low-Risk group (p = 0.0032).

High-Risk subjects had significantly higher MDS-UPDRS-II scores than the Low-Risk group (p = 0.041). There was no significant difference between all groups for MDS-UPDRS-III (p=0.082). For Purdue Pegboard Assembly subtask, there was a statistically significant group effect (p = 0.042). High Risk subjects had significantly slower 7 metre Timed-Up-Go timings than the Intermediate Risk group (p < 0.001) and with the Low-Risk group (p < 0.001).

Conclusion: Our results showed that when compared with Low-Risk subjects, High-Risk & Intermediate-Risk subjects faced significantly greater motor and non-motor impairment. By detecting subtle non-motor and motor changes through easily accessible means, it would improve PD risk stratification and early diagnosis of PD.

References: Heinzel S, Berg D, Gasser T, Chen H, Yao C, Postuma RB, et al. Update of the MDS research criteria for prodromal Parkinson’s disease. Movement Disorders [Internet]. 2019 Aug 14;34(10):1464–70. Available from: https://doi.org/10.1002/mds.27802

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prodromal-parkinsons-disease-in-singapore-motor-and-non-motor-symptom-patterns/