Objective: To compare the onset of clinical manifestations by location and motor or non-motor symptoms in patients with early- and late-onset Parkinson’s Disease (PD) from a movement disorders clinic.
Background: Motor symptoms in PD present with a heterogeneous onset in each patient, with the most common being tremors, rigidity, bradykinesia, and postural instability, which are used as criteria for the clinical diagnosis of PD. [1, 2, 3] Different clinical courses have been described based on predominant symptoms and age at PD onset. [4, 5, 6]
Method: A cross-sectional study was conducted from June 2022 to March 2025 in patients from a movement disorders clinic, using clinical surveys. Patients were divided into two groups based on the age of symptom onset: early-onset (<50 years) and late-onset. Location refers to the segment or grouping of body segments where the symptom first appeared.
Results: A total of 143 patients were included: 56 (39.2%) with early-onset and 87 (60.8%) with late-onset PD. The most frequent location of symptom onset was the left upper extremity (LUE) in 36 patients (25.2%). The most frequently reported initial clinical manifestation was tremor in 65 individuals (45.5%). When analyzing groups by PD onset, in the early-onset group, the most frequent location was LUE in 18 (32.1%) patients. The most frequent initial clinical manifestation was tremor in 25 (44.6%). In the late-onset group, the most frequent location was the right upper extremity (RUE) in 23 (26.4%). The most frequent initial clinical manifestation was tremor in 40 (46%) patients. No significant differences (p > 0.05) were found in the distribution of symptom location or type, nor was there an association with PD onset.
Conclusion: In our study, no significant difference or association was found between clinical manifestations and symptom localization based on PD onset. Tremor was the predominant symptom in both groups, followed by rigidity, with the most common localizations occurring in the right and left upper extremities. This may be explained by the fact that these segments are the most frequently used in patients’ daily lives, making the symptoms easier to identify. The study of biomarkers and classifications from the early stages of the disease could allow for a better definition of the clinical course in patients. [7, 8]
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References: 1. Bloem BR, Okun MS, Klein C. Parkinson’s disease. Lancet [Internet]. 2021;397(10291):2284–303. Disponible en: http://dx.doi.org/10.1016/S0140-6736(21)00218-X
2. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Movement Disorders. 2015 Oct;30(12):1591–601.
3. Postuma RB, Poewe W, Litvan I, Lewis S, Lang AE, Halliday G, et al. Validation of the MDS clinical diagnostic criteria for Parkinson’s disease. Movement Disorders. 2018 Aug 25;33(10):1601–8.
4. Ye H, Robak LA, Yu M, Cykowski M, Shulman JM. Genetics and Pathogenesis of Parkinson’s Syndrome. Annual Review of Pathology: Mechanisms of Disease. 2023 Jan 24;18(1):95–121.
5. Ryman SG, Poston KL. MRI biomarkers of motor and non-motor symptoms in Parkinson’s disease. Parkinsonism & Related Disorders. 2020 Apr;73:85–93.
6. Meléndez-Flores JD, M Irabien-Zuñiga, C Cerda-Contreras, de I, I Estrada-Bellmann. Parkinson’s disease phenotype based on age at onset in Latin American patients: a paired-based analysis. Revista de Neurología. 2022 Jan 1;74(9).
7. Albrecht F, Poulakis K, Freidle M, Johansson H, Ekman U, Volpe G, et al. Unraveling Parkinson’s disease heterogeneity using subtypes based on multimodal data. Parkinsonism & Related Disorders. 2022 Sep;102:19–29.
8. Deng X, Mehta A, Xiao B, Ray Chaudhuri K, Tan EK, Tan LCS. Parkinson’s disease subtypes: Approaches and clinical implications. Parkinsonism & Related Disorders [Internet]. 2024 Nov 12;130:107208. Available from: https://www.sciencedirect.com/science/article/pii/S1353802024012203
To cite this abstract in AMA style:
J. Trejo-Ayala, H. Trujillo-Guerra, J. Sánchez-Garza, D. Ortiz-Zacarías, S. Castillo-Torres, B. Chávez-Luévanos, I. Estrada-Bellmann. Heterogeneity of the First Clinical Manifestations Reported in Patients with Early- and Late-Onset Parkinson’s Disease. [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/heterogeneity-of-the-first-clinical-manifestations-reported-in-patients-with-early-and-late-onset-parkinsons-disease/. Accessed October 5, 2025.« Back to 2025 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/heterogeneity-of-the-first-clinical-manifestations-reported-in-patients-with-early-and-late-onset-parkinsons-disease/