Nonmotor signs aid Parkinson’s diagnosis

Oct 10 2013

By Eleanor McDermid, Senior medwireNews Reporter

Physicians should account for nonmotor symptoms (NMS) when diagnosing Parkinson’s disease (PD), researchers believe.

Brit Mollenhauer (Paracelsus-Elena-Klinik, Kassel, Germany) and colleagues found that NMS were common among patients with early PD and distinguished them from healthy controls with high accuracy.

The findings “suggest that the current clinical criteria of PD miss the full spectrum of clinical symptoms and signs in the early stages of PD with evolving motor symptoms, which likely reflect the nervous system–wide process of typical PD,” the team writes in Neurology.

The 159 PD patients in the study (the De Novo Parkinson study) were drug-naïve and were diagnosed according to the UK Brain Bank Criteria, which are based on motor symptoms. However, they had significantly more NMS than 110 control participants, who were matched for age, gender, and education.

Patients had significantly higher scores than controls on the NMS Questionnaire (7.5 vs 3.7) and on the NMS Scale (37.6 vs 13.1). They scored significantly higher in all areas of the Scale for Outcomes in PD for Autonomic Symptoms (Scopa-AUT), except for sexual dysfunction in women, and also had worse scores for measures of sleep.

“[I]t is evident from our study that the cross-sectional assessment of subjects with NMS requires an interdisciplinary approach in order to make an accurate diagnosis of PD,” comment Mollenhauer et al.

Combining the results from the NMS Questionnaire and Scopa-AUT Gastrointestinal distinguished between patients and controls with 81.0% accuracy. However, the highest accuracy, of 96.3%, arose with the addition of findings from the Smell Identification Test, serum cholesterol and heart rate measurements, transcranial sonography of the substantia nigra, and polysomnography.

For “easy screening purposes,” questionnaire findings plus olfactory, electrocardiography, and serum cholesterol testing gave an accuracy of 91.3%, note the researchers.

They plan further research in the same cohort to determine whether these markers are able to track disease progression or predict which patients will develop specific subtypes of PD.

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