Objective: To assess the temporal profile of motor and non-motor symptoms in Parkinson’s disease.

Background: Parkinson’s disease is characterized by varying combinations of motor and non-motor symptoms. An understanding of the relationship between the presentation and progression of clinical symptoms will enable more effective diagnosis and treatment.

Methods: PD patients are followed at annual intervals. Using structured clinical documentation support tools built into the electronic medical record, we capture the following measures: age at onset and diagnosis, disease duration, Montreal Cognitive Assessment, Short Test of Mental Status, Epworth Sleepiness Scale, Geriatric Depression Scale, Nine Hole Peg Test, Unified Parkinson’s disease Rating Scale, Hoehn and Yahr stage, Schwab and England activities of daily living scale, and complications of dopaminergic therapy. Statistical analyses are used to correlate individual symptoms, groups of symptoms and their temporal profile.

Results: 514 PD patients (65% male, 92.0% Caucasian) were enrolled using the Bower diagnostic criteria. Median age at diagnosis was 66.5 yr (range 30-92) and median disease duration was 3 yr (range 3-43). 71.8% were receiving dopaminergic therapy. Median disease duration free of dyskinesias was 7.5 yr (range 1-18). The most common initial symptoms, in descending order, were tremor, generalized bradykinesia, reduced arm swing and reduced dexterity, whereas the initial non-motor symptoms were anosmia, cognitive impairment, REM sleep behavior disorder and constipation. While the most common initial motor symptom was tremor, the most common motor symptom at enrollment was bradykinesia, followed in descending order by tremor, gait problems, rigidity, freezing, motor fluctuations and dyskinesias. The most common non-motor symptom was anosmia, followed by constipation, insomnia, depression and cognitive impairment.

Conclusions: In this well characterized PD cohort in a clinical practice setting, both motor and non-motor symptoms are present at disease onset. With disease progression, there is a change in the predominant symptom with bradykinesia gradually replacing tremor. While this transition may be characteristic of disease progression, treatment effects cannot be excluded. Statistical analysis including Markov state transition models will characterize the temporal profile of symptom progression and appearance of complications of therapy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/symptom-progression-in-a-large-cohort-of-parkinsons-disease-cases-in-a-clinical-practice-setting/