Parkinson’s-like symptoms found to be common in ‘oldest old’ in study

Findings highlight need for better definition of MPS in Parkinson's

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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Many elderly people who do not have Parkinson’s disease nonetheless experience some Parkinson’s-like symptoms, especially slowness of movement, a new study from Sweden highlights.

These symptoms, while reported to impact quality of life, typically are not enough to warrant a formal Parkinson’s diagnosis. Instead, they’re often referred to as mild parkinsonian signs, or MPS.

In their study, the researchers suggest that health problems may explain the greater occurrence of MPS among older people, but also note that these symptoms might just be a normal part of aging. Either way, the team noted, the common occurrence of parkinsonian signs found in assessing the elderly may require evaluating what exactly defines MPS.

“The high prevalence of MPS … in this study could indicate the need to revise the definitions of MPS in older adults,” the team wrote.

The study, “Prevalence and functional impact of parkinsonian signs in older adults from the Good Aging in Skåne study,” was published in Parkinsonism and Related Disorders.

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Parkinson’s symptoms may or may not qualify disease diagnosis

Parkinson’s disease is characterized by motor symptoms such as tremor, stiffness, balance problems, and unusually slowed movements known as bradykinesia. To be formally diagnosed with Parkinson’s, a person has to experience at least two of these symptoms over a period of time.

Some people may experience minor problems that are similar to one or more Parkinson’s symptoms, but which are not enough to qualify a disease diagnosis. Instead, the patient is said to have MPS.

Several definitions for MPS have been proposed, but to date there is not a consensus on what exactly constitutes mild parkinsonian signs. Depending on the definition, sometimes the terms “parkinsonism” or “subthreshold parkinsonian signs” are used instead of MPS; all of these terms refer to Parkinson’s-like signs that aren’t enough to facilitate a formal diagnosis.

In this study, scientists assessed the prevalence of MPS among 559 community-dwelling elderly adults, ages 80 to 102. The participants were part of the population-based study “Good Aging in Skåne” (GÅS study) and were randomly invited from both urban and rural areas in southern Sweden using the National Population Register. The GÅS study began in 2001 and is still underway.

Participants completed standardized assessments of cognitive function and life quality, as well as answering questions about their physical activity and fear of falling.

Each of the participants was evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS), a standardized assessment of Parkinson’s motor symptom severity. The researchers then used one of four previously proposed definitions to assess the prevalence of MPS. For example, one definition categorized MPS as a score higher than 3, while another categorized it as scores higher than zero in specific domains or categories of the test.

“There is a significant overlap between the definitions,” the researchers noted.

The results showed that, based on two of the definitions, more than 80% of the study’s participants met the criteria for MPS. Based on the third definition, more than half (57.5%) met the criteria. Even with the most restrictive definition used, nearly 1 of 5 of these older adults (17.2%) met criteria for MPS.

In future revisions of definitions of MPS or parkinsonism in the oldest old, a revised assessment of bradykinesia might need to be more precise when detecting parkinsonian signs.

Statistical analyses showed that patients who met criteria for MPS were significantly more likely to show signs of cognitive impairment and more likely to report fear of falling. They also were more likely to have urinary incontinence. Overall, these individuals tended to report less physical activity and worse life quality.

More detailed analyses of UPDRS scores showed that bradykinesia was particularly common among these older adults, whereas other Parkinson’s-like symptoms were less frequently reported. This findings suggest a need for “discussion about relevance of using the concept of MPS without distinguishing parkinsonism in older adults [older than] 80 yrs, and whether the term MPS is relevant to use in the very oldest.”

Specifically, the researchers noted, the “predominance of bradykinesia in the oldest old might indicate a need for revision of MPS definitions.” There is “no standardized definition of detection of MPS in older adults over 80 years,” the team noted.

Have such a definition might allow clinicians to detect possible cognitive and motor decline earlier in older people, the researchers noted.

“In future revisions of definitions of MPS or parkinsonism in the oldest old, a revised assessment of bradykinesia might need to be more precise when detecting parkinsonian signs,” they wrote.