Motor and non-motor features of Parkinson's disease that predict persistent drug-induced Parkinsonism |
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| Affiliation: | 1. Bakirkoy Education and Research Hospital, Ophthalmology Department, Istanbul, Turkey;2. Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Neurology Department, Istanbul, Turkey;1. University of South Florida Morsani College of Medicine, Department of Internal Medicine, Division of Allergy/Immunology, Tampa, FL, USA;2. Medical Genetics Unit, Istituto Giannina Gaslini, Genoa, Italy;3. Hematology Unit, Istituto Giannina Gaslini, Genoa, Italy;4. Stem Cell Transplantation Unit, Istituto Giannina Gaslini, Genoa, Italy;5. Department of Allergy & Immunology, Massachusetts General Hospital, Boston, MA, USA;6. Department of Cancer Immunology, Oslo University Hospital Radiumhospitalet, Oslo, Norway;7. Laboratory of Clinical Immunology and Microbiology, NIAID, National Institutes of Health, Bethesda, MD, USA;8. University of South Florida at Johns Hopkins All Children''s Hospital, Division of Pediatric Allergy/Immunology, St. Petersburg, FL, USA;9. Division of Pediatric Allergy and Immunology, Massachusetts General Hospital for Children, Boston, MA, USA |
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| Abstract: | BackgroundDrug-induced Parkinsonism is common, causes significant morbidity, and can be clinically indistinguishable from idiopathic Parkinson's disease. Additionally, drug-induced Parkinsonism may, in some cases, represent “unmasking” of incipient Parkinson's disease. Clinical features or tests that distinguish degenerative from pharmacologic Parkinsonism are needed.MethodsWe performed a retrospective case-control study of 97 drug-induced Parkinsonism subjects and 97 age-matched patients with Parkinson's disease. We compared the frequency of subjective motor and non-motor complaints, objective motor findings (Unified Parkinson's Disease Rating Scale Part III) and, where available, objective olfactory tests. We also performed a nested case-control study wherein we compared these same features between drug-induced Parkinsonism patients based on whether or not they recovered after changing the offending agent.ResultsNon-motor symptoms including constipation and sexual dysfunction were more common in Parkinson's disease than in drug-induced Parkinsonism. While total motor scores were similar between groups, Postural Instability-Gait Difficulty scores were also higher in Parkinson's disease. Features that were significantly different or showed a trend towards significance in both comparisons included subjective loss of facial expression, dream-enactment behavior, autonomic complaints and Postural Instability-Gait Difficulty scores. Hyposmia was more common in Parkinson's disease and was strongly predictive of persistent drug-induced Parkinsonism after therapy change (odds ratio 30.3, 95% confidence interval: 1.5–500, p = 0.03).ConclusionsA constellation of motor and non-motor features may differentiate unmasked Parkinson's disease from drug-induced Parkinsonism. In particular, olfactory testing may offer a simple and inexpensive method to help predict outcomes in drug-induced Parkinsonism and, potentially, identify a cohort of pre-motor Parkinson's disease. |
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| Keywords: | Drug-induced Parkinsonism Parkinson's disease Non-motor symptoms Olfactory dysfunction |
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