title: Nonmotor symptoms as presenting complaints in Parkinson's disease: a clinicopathological study.
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 orthopedic surgeons or rheumatologists than neurologists (nonmotor group 5.5% vs. motor group 44.2%, chi(2) P < 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 (chi(2) P = 0.016).
authors.affiliation: Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, United Kingdom.
authors.forename: Sean S
authors.initials: SS
authors.lastname: O'Sullivan
authors.forename: David R
authors.initials: DR
authors.lastname: Williams
authors.forename: David A
authors.initials: DA
authors.lastname: Gallagher
authors.forename: Luke A
authors.initials: LA
authors.lastname: Massey
authors.forename: Laura
authors.initials: L
authors.lastname: Silveira-Moriyama
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lees
mesh_terms: D001921:Brain / Q000503:physiopathology*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D003937:Diagnosis, Differential; D020329:Essential Tremor / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D009462:Neurology / Q000706:statistics & numerical data; D000857:Olfaction Disorders / Q000175:diagnosis / Q000453:epidemiology; D009985:Orthopedics / Q000706:statistics & numerical data; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology; D010300:Parkinson Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012219:Rheumatology / Q000706:statistics & numerical data; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology; D014549:Urinary Incontinence / Q000175:diagnosis / Q000453:epidemiology*