Schrag, A;
Zhelev, SS;
Hotham, S;
Merritt, RD;
Khan, K;
Graham, L;
(2019)
Heterogeneity in progression of prodromal features in Parkinson's disease.
Parkinsonism & Related Disorders
, 64
pp. 275-279.
10.1016/j.parkreldis.2019.05.013.
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Schrag Paper_Symptom co-occurrence revised 10th Jan 2019 no highlighted changesx.pdf - Accepted Version Download (803kB) | Preview |
Abstract
Background: In the pre-diagnostic phase of Parkinson's disease (PD), a range of motor and non-motor symptoms can occur. However, there is considerable variability in their onset and currently little information exists on the pattern of progression of clinical features before diagnosis. / Methods: We analysed data from a survey amongst patients with PD from 11 European countries by the European Parkinson's Disease Association. They completed questions on first occurrence of 21 pre-diagnostic features. A principal component analysis (PCA) with varimax rotation was performed to determine the co-occurrence of these features. / Findings: 1467 patients were included. Changes in movement were the most commonly reported features up to 4 years before diagnosis. However, at five or more years before diagnosis loss of sense of smell, sleep problems, fatigue and other non-motor features had been experienced most frequently. PCA of pre-diagnostic features' duration revealed three factors with eigenvalues over Kaiser's criterion of 1: a) a neuropsychiatric factor comprised of anxiety, depression, apathy, stress, and sleep problems; b) an axial factor defined by difficulty eating and/or swallowing problems, freezing, and falls/balance problems; and c) a motor factor with additional non-motor features. Bladder/bowel problems and tremor had low factor loadings on all components. However, in those with disease duration less than 5 years the autonomic features were associated with the axial factor and tremor loaded on both the motor and psychiatric symptom factors. / Interpretation: The identified symptom complexes in the pre-diagnostic stage of PD may be reflective of a shared pattern of pathological disease progression.
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