Skip to main content

Heterogeneity in progression of prodromal features in Parkinson’s disease

Schrag, A., Zhelev, S.S., Hotham, Sarah, Merritt, Rowena K., Khan, K., Graham, L. (2019) Heterogeneity in progression of prodromal features in Parkinson’s disease. Parkinsonism & Related Disorders, 64 . pp. 275-279. ISSN 1353-8020. E-ISSN 1873-5126. (doi:10.1016/j.parkreldis.2019.05.013) (KAR id:75360)

PDF Author's Accepted Manuscript
Language: English
Download (902kB) Preview
[thumbnail of Heterogeneity in PD progression.pdf]
This file may not be suitable for users of assistive technology.
Request an accessible format
XML Word Processing Document (DOCX) Author's Accepted Manuscript
Language: English

Restricted to Repository staff only
Contact us about this Publication
[thumbnail of Paper_Symptom co-occurrence revised 10th Jan 2019 no highlighted changesx.docx]
Official URL


Background: In the pre-diagnostic phase of Parkinson’s disease (PD), a range of motor and non-motor symptoms can occur. However, there is considerable variability in their onset and currently little information exists on the pattern of progression of clinical features before diagnosis. Methods: We analysed data from a survey amongst patients with PD from 11 European countries by the European Parkinson’s Disease Association. They completed questions on first occurrence of 21 pre-diagnostic features. A principal component analysis (PCA) with varimax rotation was performed to determine the co-occurrence of these features. Findings: 1,467 patients were included. Changes in movement were the most commonly reported features up to 4 years before diagnosis. However, at five or more years before diagnosis loss of sense of smell, sleep problems, fatigue and other non-motor features had been experienced most frequently. PCA of pre-diagnostic features’ duration revealed three factors with eigenvalues over Kaiser’s criterion of 1: a) a neuropsychiatric factor comprised of anxiety, depression, apathy, stress, and sleep problems; b) an axial factor defined by difficulty eating and/or swallowing problems, freezing, and falls/balance problems; and c) a motor factor with additional non-motor features. Bladder/bowel problems and tremor had low factor loadings on all components. However, in those with disease duration less than 5 years the autonomic features were associated with the axial factor and tremor loaded on both the motor and psychiatric symptom factors. Interpretation: The identified symptom complexes in the pre-diagnostic stage of PD may be reflective of a shared pattern of pathological disease progression.

Item Type: Article
DOI/Identification number: 10.1016/j.parkreldis.2019.05.013
Uncontrolled keywords: Parkinson's disease; Prediagnostic phase; Subtypes; Symptom complex; Progression
Subjects: H Social Sciences
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies
Depositing User: Meg Dampier
Date Deposited: 16 Jul 2019 13:10 UTC
Last Modified: 29 Oct 2021 14:33 UTC
Resource URI: (The current URI for this page, for reference purposes)
Hotham, Sarah:
Merritt, Rowena K.:
  • Depositors only (login required):