Nonmotor symptoms as presenting complaints in Parkinson's disease: A clinicopathological study

Authors

  • Sean S. O'Sullivan MRCPI,

    1. Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, United Kingdom
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  • David R. Williams PhD,

    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
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  • David A. Gallagher MRCP,

    1. Department of Clinical Neurosciences, Royal Free and University College Medical School, London, United Kingdom
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  • Luke A. Massey MRCP,

    1. Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, United Kingdom
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  • Laura Silveira-Moriyama MD,

    1. Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, United Kingdom
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  • Andrew J. Lees FRCP

    Corresponding author
    1. Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, United Kingdom
    • Reta Lila Weston Institute of Neurological Studies, UCL, 1 Wakefield Street, London, WC1N 1PJ
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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%, χ2P < 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 (χ2P = 0.016). © 2007 Movement Disorder Society

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