Objective: To describe trajectories of physical performance in prodromal and early Parkinson’s Disease (PD).

Background: There is a need to better characterize the prodromal and early period of PD to enable prompt diagnosis and more accurately track disease progression. Standard measures such as the MDS-UPDRS are not as sensitive to change in early PD, so there is growing interest in measures of functional mobility and physical performance to detect and track subtle motor changes.

Method: We analyzed data from 9,568 women (mean age 70.7+/- 4.3) and 5,648 men (mean age 73.1 +/- 5.5) enrolled in two prospective cohort studies of community-dwelling older adults followed up to 20 years. PD was repeatedly ascertained by self-reported physician diagnosis and medication use over follow-up. We excluded individuals with prevalent PD at baseline (n=99). Participants regularly completed measures of grip strength (kg), 6-m walking speed (usual pace in m/s), and chair stands (seconds to complete 5). We estimated the associations of PD diagnosis with rates of change in these measures in the pre-diagnostic period compared to controls using mixed-effects models adjusted for age, sex, education, race, body mass index, smoking, alcohol use, depression, and cardiovascular risk factors.

Results: There were 290 individuals who reported an incident diagnosis of PD during the study (mean follow-up time prior to diagnosis 10.1 +/-5.4 years). Compared to rates of decline over time in older adults without PD, participants with PD worsened more quickly in their walking speed by 0.01 m/s per year (p<0.001) and their chair stand time by 0.07 seconds per year (p=0.046) before their diagnosis. Grip strength did not decline more quickly in those with PD before diagnosis compared to those who never developed PD.

Conclusion: Individuals with prodromal and early PD exhibited annual slowing in their walking speed and chair stands that detectably differed from normal aging. Physical performance measures may facilitate sooner PD diagnosis and inform the development of outcome measures to determine the efficacy of early interventions. Future research is needed to evaluate the predictive value of adding functional mobility measures to existing prodromal risk assessments and explore their passive measurement through wearable devices.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/trajectories-of-physical-performance-in-prodromal-and-early-parkinsons-disease/