Nonmotor symptoms as presenting complaints in Parkinson's disease: A clinicopathological study |
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Authors: | Sean S O'Sullivan MRCPI David R Williams PhD David A Gallagher MRCP Luke A Massey MRCP Laura Silveira‐Moriyama MD Andrew J Lees FRCP |
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Institution: | 1. Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, United Kingdom;2. Faculty of Medicine (Neuroscience), Monash University (Alfred Hospital Campus), Melbourne, Australia;3. Department of Clinical Neurosciences, Royal Free and University College Medical School, London, United Kingdom |
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Abstract: | Nonmotor symptoms (NMS) are increasingly recognized as a significant cause of morbidity in later stages of Parkinson's disease (PD). Prodromal NMS are also a well recognized component of the clinical picture in some patients but the prevalence of NMS as presenting complaints, and their impact on clinical management, in pathologically‐proven cases of PD is unknown. The presenting complaints of 433 cases of pathologically‐proven PD archived at the Queen Square Brain Bank for Neurological Diseases were identified from the clinical case notes. 91/433 (21%) of patients with PD presented with NMS of which the most frequent were pain (15%), urinary dysfunction (3.9%), anxiety, or depression (2.5%). Presenting with NMS is associated with a delayed diagnosis of PD (Mann‐Whitney U, P = 0.001). These patients were more likely to be misdiagnosed initially and were more likely to have been referred to orthopedeic surgeons or rheumatologists than neurologists (nonmotor group 5.5% vs. motor group 44.2%, χ2 P < 0.0001). NMS are commonly seen as presenting complaints in pathologically confirmed PD, and initial misdiagnosis may be associated with potentially inappropriate medical interventions. Presenting with NMS does not affect the motor response to medication, but is associated with shorter disease duration (χ2 P = 0.016). © 2007 Movement Disorder Society |
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Keywords: | Parkinson disease nonmotor pain depression autonomic |
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