Objective: To describe the temporal sequence of Non-motor symptoms (NMS)relative to first motor symptom onset using a single-page, outpatient-friendly temporal profile template.

Background: NMS often precede motor manifestations in Parkinson’s disease (PD), but their temporal dynamics are poorly characterized(1). Most studies focus non-motor symptom prevalence, with limited attention on their temporal relationship to motor onset(2). To address this gap, we developed a single-page temporal profile template designed to facilitate easy collection of NMS onset data in routine outpatient settings.

Method: 100 consecutive PD patients attending outpatient clinic were assessed using a single-page temporal profile template capturing NMS onset relative to first motor symptom. Median onset times, frequency before motor onset, and clustering patterns were analysed.

Results: A total of 100 patients diagnosed with PD with mean age of 58.24± 11.16 years (range 29–81 years) and male predominance (69%) were included in the study. The mean age of onset was 51.19 ±12.63 years (range 15-76 years) and the mean disease duration at the time of evaluation was 7.28± 5.39 years. All participants were evaluated in outpatient clinic using the newly developed temporal profile template designed to systematically capture the onset of NMS relative to the onset of motor symptoms. The most common initial motor manifestation was resting tremor (77%), followed by bradykinesia (68%) and rigidity (34% ). At least one NMS were reported in 96% of patients and Multiple NMS were reported by 74% of participants. Prodromal NMS were reported in 26% of patients. Constipation(50%), mood changes (48%), and RBD(28%) were among the most frequently reported early symptoms, occurring at a median of 4 years (IQR:3–7 years), 5 years (IQR:4–15.5 years) and 5 years (IQR:4–7 years) respectively before motor onset. Other symptoms, including hyposmia, and autonomic dysfunction were noted in smaller proportion. Cognitive symptoms, psychosis and sensory complaints, appeared later in the course of the illness

Conclusion: Temporal profiling of NMS is feasible in routine outpatient settings and highlights early prodromal markers, which may aid earlier PD detection. Prodromal gastrointestinal, mood and REM sleep symptoms found to precede autonomic and cognitive complications.

Heat map showing the onset of prodromal NMS.

References: 1. Chaudhuri KR, Healy DG, Schapira AHV, National Institute for Clinical Excellence. Non-motor symptoms of Parkinson’s disease: diagnosis and management. Lancet Neurol. 2006 Mar;5(3):235–45. doi:10.1016/S1474-4422(06)70373-8 PubMed PMID: 16488379.
2. Postuma RB, Berg D. Prodromal Parkinson’s Disease: The Decade Past, the Decade to Come. Mov Disord. 2019;34(5):665–75. doi:10.1002/mds.27670

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mapping-the-temporal-evolution-of-non-motor-symptoms-in-parkinsons-disease-findings-from-100-outpatient-cases-using-a-single-page-temporal-template/