Affiliations: [a]
Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| [b] Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| [c]
Department of Neurology, General Hospital, Zacatecas, Zacatecas, México | [d]
Department of Neurology, General Hospital, Mérida, Yucatan, Mexico
| [e] Movement Disorder Clinic, Hospital Universitario, Monterrey, Nuevo Leon, Mexico
| [f] Movement Disorder Clinic, Hospital Civil, Guadalajara, Jalisco, Mexico
Correspondence:
[*]
Correspondence to: Mayela Rodríguez Violante, Movement Disorders Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur #3877 Col. La Fama 14269 Mexico City, Mexico. Tel.: +525556063822/Ext: 5018; Fax: +525551716456; E-mail: mrodriguez@innn.edu.mx.
Abstract: Background: Parkinson’s disease is characterized by motor and non-motor clinical features. The latter may present as pre-motor symptoms several years before the motor onset. Objective: To analyze the association between pre-motor symptoms load and its lead-time in relation to the motor onset and time to diagnosis. Methods: A cross-sectional study was carried including subjects with Parkinson’s disease from five different movement disorders clinics in Mexico. A structured questionnaire was applied to assess the presence of six self-perceived pre-motor symptoms (hyposmia, depression, anxiety, constipation, pain and sleep disorders). Results: Overall frequency of pre-motor symptoms was 76.2% . Among the most prevalent symptoms were depression (38%), sleep disorders (37%) and anxiety (36.6%). The lead time to motor onset was greater for constipation (9.2±17.89 years) and pain (8.66±13.36 years). Patients with more than two pre-motor symptoms had a later age at motor onset when compared to patients without pre-motor symptoms (52.04±13.11 vs 56.55±12.97 years, p = 0.037). Late onset patients had a higher frequency of pre-motor symptoms (79% vs 65% in early onset, p = 0.002) and a higher load (1.75±1.37 vs 1.44±1.38, p = 0.033) in comparison to those with early onset. Female subjects reported a higher number of pre-motor symptoms (1.91±1.43 versus 1.48±1.29, p≤0.001). PIGD patients reported a greater frequency of pain (8%) compared to tremor (1%, p = 0.0064) and bradykinetic-rigid (0.61%, p = 0.0061). Anxiety lead-time was greater in tremor-dominant (10.83±15.77 years) compared to bradykinetic-rigid patients (3.48±12.56, p = 0.014). Conclusions: Pre-motor symptoms load is associated to a later motor onset of PD. Pre-motor symptoms are more frequent in subjects with late onset Parkinson’s disease. Female subjects report a higher number of pre-motor symptoms, depression and anxiety being the most common.
Keywords: Parkinson’s disease, pre-motor symptoms, non-motor symptoms, motor onset
