Early Symptoms of Parkinson’s Disease Evident Years Before Diagnosis, Study Shows

Early Symptoms of Parkinson’s Disease Evident Years Before Diagnosis, Study Shows

Shortcomings in daily activities such as housework, meal preparations, money management, and shopping, which require both motor and non-motor skills, precede difficulties in more physically oriented daily activities in patients with pre-diagnostic Parkinson’s disease, according to a study published in the scientific journal Brain.

This is an important finding because it can help physicians diagnose Parkinson’s disease earlier and could help manage the condition better.

The study “Trajectories of prediagnostic functioning in Parkinson’s disease” is the first that describes the order in which motor and non-motor shortfalls affecting daily functioning in Parkinson’s disease patients happen.

The team of researchers led by Arfan Ikram, MD, PhD, of the Erasmus MC University Mecial Center Rotterdam in the Netherlands. studied the trajectory of daily functioning and motor and non-motor functions in the 23 years before the diagnosis of Parkinson’s disease. He did so by implementing a nested case-control study within the Rotterdam study, which analyzed almost 8,000 people living in Ommoord in the Netherlands, aged 55 and older.

The researchers repeatedly assessed the daily functioning of the participants between 1990 and 2013 using the Stanford Health Assessment Questionnaire and the Lawton Instrumental Activities of Daily Living Scale.

To assess potential pre-diagnostic motor function, the researchers used slowness or loss of muscle movements, tremor, rigidity, imbalance, or abnormal posture.

Finally, they assessed non-motor features of Parkinson’s disease, including cognition, mood, and autonomic function using several standardized tests, including the Mini-Mental State Examination, the Stroop Test, the Letter-Digit-Substitution Test, the Word Fluency Test, Center for Epidemiological Studies-Depression Scale, Hamilton Anxiety and Depression Scale, blood pressure, and laxative use.

The researchers also followed the participants with repeated in-person examinations, and by accessing their medical records.

In this period of time, 109 people were diagnosed with Parkinson’s disease. The researchers matched every one of them to 10 people of the same age and sex without Parkinson’s disease as a control.

When they compared the daily functioning of people who were later diagnosed with Parkinson’s disease with those who were not, the researchers found that from seven years before diagnosis onward, people who later were diagnosed with Parkinson’s disease more often had problems in instrumental daily activities. They also more frequently showed signs of movement difficulty and slowness, tremor and subtle cognitive deficits.

In the five years before diagnosis, people who later were diagnosed with Parkinson’s disease developed additional motor problems such as imbalance, rigidity and abnormal posture, and increasingly reported problems in basic daily activities.

Finally, people who later were diagnosed with Parkinson’s disease increasingly reported anxiety symptoms, depressive symptoms, and use of laxatives throughout study follow-up. However, the differences with people who were not diagnosed subsequently with Parkinson’s disease became statistically significant only in the last years before diagnosis.

It already was known that some patients who were diagnosed with Parkinson’s disease had symptoms preceding the diagnosis of the condition. However, this is the first study that describes in detail the sequence of these so-called prodromal symptoms.

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Özge has a MSc. in Molecular Genetics from the University of Leicester and a PhD in Developmental Biology from Queen Mary University of London. She worked as a Post-doctoral Research Associate at the University of Leicester for six years in the field of Behavioural Neurology before moving into science communication. She worked as the Research Communication Officer at a London based charity for almost two years.


  1. Ros Cassidy says:

    I agree with this finding, I had no sense of smell for at least 5 years prior to my diagnosis of Parkinsons Disease. I was diagnosed in 2006 at the age of 53.Thanks for the article. Cheers Ros Cassidy

  2. Marie says:

    I agree with the article, there is a prevalent history in my family. My paternal grandma, my dad and his twin sister whom have all since died. I noticed with my dad 4 to 5 years before his diagnosis eating and swallowing problems and c/o constipation, cognitive difficulty also noticed. His primary care physician was treating his various symptoms, however I finally convinced him to see the neurologist that my aunt his twin was seeing (she had Lewey Body) he was easily diagnosed at his first appointment. I am 60 and sometimes think I to have PD too, being a nurse I am familiar with symptoms but have procrastinated on seeing a neurologist, I guess stubborn like my dad was and not wanting to know.

  3. Maureen Charamuga says:

    Most of the things mentioned can also be a symptom of another issue. People with depression,anxiety, Bipolar do not all have PD. Some minor cognitive impairment is often caused by medications and balance by vision issues. An injury to a leg can cause a person to not be able to walk a straight line or balance on one foot. Sleeping on a bad mattress can effect the posture of an individual and tremor in movement from a medication. During this study did the individuals who later were found to have PD have it worse than if they had taken medication? I do not understand how a diagnosis can be made without following the health of an individual and if they have it the progression on the things mentioned above. I do not see where a person with a different than normal gait could not have a foot problem which causes may different symptoms. If a person goes on medication immediately following a diagnosis would help many of the above physical symptoms and not have PD. I have heard of false positive for PD but do not know how that is determined if the medication is working on things besides PD Diagnosis.How many of the symptoms are necessary for as possible a diagnosis being correct. Does age play into this as well? I found the article informative but I was asking these questions while reading it. Just my thoughts I am not discounting that a person not be seen by a specialist but that they ask many of the same questions.

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