title: Self-Perceived Pre-Motor Symptoms Load in Patients with Parkinson's Disease: A Retrospective Study.
abstract: BACKGROUND
  Parkinson's disease is characterized by motor and non-motor clinical features. The latter may present as pre-motor symptoms several years before the motor onset.
  
  
  OBJECTIVE
  To analyze the association between pre-motor symptoms load and its lead-time in relation to the motor onset and time to diagnosis.
  
  
  METHODS
  A cross-sectional study was carried including subjects with Parkinson's disease from five different movement disorders clinics in Mexico. A structured questionnaire was applied to assess the presence of six self-perceived pre-motor symptoms (hyposmia, depression, anxiety, constipation, pain and sleep disorders).
  
  
  RESULTS
  Overall frequency of pre-motor symptoms was 76.2% . Among the most prevalent symptoms were depression (38%), sleep disorders (37%) and anxiety (36.6%). The lead time to motor onset was greater for constipation (9.2 ± 17.89 years) and pain (8.66 ± 13.36 years). Patients with more than two pre-motor symptoms had a later age at motor onset when compared to patients without pre-motor symptoms (52.04 ± 13.11 vs 56.55 ± 12.97 years, p = 0.037). Late onset patients had a higher frequency of pre-motor symptoms (79% vs 65% in early onset, p = 0.002) and a higher load (1.75 ± 1.37 vs 1.44 ± 1.38, p = 0.033) in comparison to those with early onset. Female subjects reported a higher number of pre-motor symptoms (1.91 ± 1.43 versus 1.48 ± 1.29, p ≤ 0.001). PIGD patients reported a greater frequency of pain (8%) compared to tremor (1%, p = 0.0064) and bradykinetic-rigid (0.61%, p = 0.0061). Anxiety lead-time was greater in tremor-dominant (10.83 ± 15.77 years) compared to bradykinetic-rigid patients (3.48 ± 12.56, p = 0.014).
  
  
  CONCLUSIONS
  Pre-motor symptoms load is associated to a later motor onset of PD. Pre-motor symptoms are more frequent in subjects with late onset Parkinson's disease. Female subjects report a higher number of pre-motor symptoms, depression and anxiety being the most common.
authors.affiliation: Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.|Movement Disorder Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
authors.forename: Mayela
authors.initials: M
authors.lastname: Rodríguez-Violante
authors.affiliation: Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
authors.forename: Adib Jorge
authors.initials: AJ
authors.lastname: de Saráchaga
authors.affiliation: Clinical Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
authors.forename: Amin
authors.initials: A
authors.lastname: Cervantes-Arriaga
authors.affiliation: Department of Neurology, General Hospital, Zacatecas, Zacatecas, México.
authors.forename: Roxanna
authors.initials: R
authors.lastname: Millán-Cepeda
authors.affiliation: Department of Neurology, General Hospital, Mérida, Yucatan, Mexico.
authors.forename: Roberto
authors.initials: R
authors.lastname: Leal-Ortega
authors.affiliation: Movement Disorder Clinic, Hospital Universitario, Monterrey, Nuevo Leon, Mexico.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Estrada-Bellmann
authors.affiliation: Movement Disorder Clinic, Hospital Civil, Guadalajara, Jalisco, Mexico.
authors.forename: Carlos
authors.initials: C
authors.lastname: Zuñiga-Ramírez
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology; D003248:Constipation / Q000453:epidemiology* / Q000209:etiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D015995:Prevalence; D012189:Retrospective Studies; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires
keywords: Parkinson’s disease; motor onset; non-motor symptoms; pre-motor symptoms