title: Are Upper-Body Axial Symptoms a Feature of Early Parkinson's Disease?
abstract: BACKGROUND
  Axial disorders are considered to appear late in the course of Parkinson's disease (PD). The associated impact on quality of life (QoL) and survival and the lack of an effective treatment mean that understanding and treating axial disorders is a key challenge. However, upper-body axial disorders (namely dysarthria, swallowing and breathing disorders) have never been prospectively assessed in early-stage PD patients.
  
  
  OBJECTIVE
  To characterize upper-body axial symptoms and QoL in consecutive patients with early-stage PD.
  
  
  METHODS
  We prospectively enrolled 66 consecutive patients with early-stage PD (less than 3 years of disease progression) and assessed dysarthria, dysphagia and respiratory function (relative to 36 controls) using both objective and patient-reported outcomes.
  
  
  RESULTS
  The mean disease duration was 1.26 years and the mean UPDRS motor score was 19.4 out of 108. 74% of the patients presented slight dysarthria (primarily dysprosodia). Men appeared to be more severely affected (i.e. dysphonia). This dysfunction was strongly correlated with low swallowing speed (despite the absence of complaints about dysphagia), respiratory insufficiency and poor QoL. Videofluorography showed that oral-phase swallowing disorders affected 60% of the 31 tested patients and that pharyngeal-phase disorders affected 21%. 24% of the patients reported occasional dyspnea, which was correlated with anxiety in women but not in men. Marked diaphragmatic dysfunction was suspected in 42% of the patients (predominantly in men).
  
  
  CONCLUSIONS
  Upper body axial symptoms were frequent in men with early-stage PD, whereas women presented worst non-motor impairments. New assessment methods are required because currently available tools do not reliably detect these upper-body axial disorders.
authors.affiliation: Department of Neurology and Movement Disorders, CHU, Lille, France.|INSERM UMR_S 1171, Lille, France.|University of Lille, Lille, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Moreau
authors.affiliation: Department of Neurology and Movement Disorders, CHU, Lille, France.|Department of Medical Pharmacology, Disorders, CHU, Lille, France.|INSERM UMR_S 1171, Lille, France.|University of Lille, Lille, France.
authors.forename: David
authors.identifier: http://orcid.org/0000-0002-2417-799X
authors.initials: D
authors.lastname: Devos
authors.affiliation: Department of Neurology and Movement Disorders, CHU, Lille, France.|INSERM UMR_S 1171, Lille, France.|University of Lille, Lille, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Baille
authors.affiliation: Department of Clinical Neurophysiology, Disorders, CHU, Lille, France.|INSERM UMR_S 1171, Lille, France.|University of Lille, Lille, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Delval
authors.affiliation: Department of Clinical Neurophysiology, Disorders, CHU, Lille, France.|INSERM UMR_S 1171, Lille, France.|University of Lille, Lille, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Tard
authors.affiliation: Department of Pulmonology, CHU, Lille, France.|University of Lille, Lille, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Perez
authors.affiliation: Department of Nutrition, Lille CHU, Lille, France.|University of Lille, Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danel-Buhl
authors.affiliation: Department of Nutrition, Lille CHU, Lille, France.|University of Lille, Lille, France.
authors.forename: David
authors.initials: D
authors.lastname: Seguy
authors.affiliation: Department of Biostatistics, CHU, Lille, France.|University of Lille, Lille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.affiliation: Department of Biostatistics, CHU, Lille, France.|University of Lille, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Department of Neurology and Movement Disorders, CHU, Lille, France.|INSERM UMR_S 1171, Lille, France.|University of Lille, Lille, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Delliaux
authors.affiliation: Department of Neurology and Movement Disorders, CHU, Lille, France.|INSERM UMR_S 1171, Lille, France.|University of Lille, Lille, France.
authors.forename: Kathy
authors.initials: K
authors.lastname: Dujardin
authors.affiliation: Department of Neurology and Movement Disorders, CHU, Lille, France.|INSERM UMR_S 1171, Lille, France.|University of Lille, Lille, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Defebvre