Table 3:

Early and late motor and nonmotor features in patients with Parkinson disease

Early motor features30,31Early nonmotor features (may precede the diagnosis)Late features (usually develop 5–10 yr after disease onset)3134Late nonmotor features3134
  • Difficulty turning in bed

  • Frozen shoulder

  • Stiffness, numbness or pain in limb

  • Micrographia35

  • Difficulty with fine finger movements (bradykinesia)

  • Tremor of hand, jaw, foot

  • Decreased facial expression

  • Decreased arm swing, dragging a leg

  • Soft voice (“Do people ask you to repeat yourself over the phone?”)

  • Constipation (30%)34

  • REM sleep behaviour disorder* (50%, often preceding the diagnosis by median of 14 yr)3638

  • Depression occurs with a prevalence of 35% in Parkinson disease, and 10%–15% will have depression at the time of diagnosis39

  • Olfaction impairment (most consistent nonmotor feature predicting Parkinson disease); up to 97% of patients34,40,41

  • Motor fluctuations

  • Dyskinesia (complication of dopaminergic treatment, more so with levodopa); typically choreiform, involving the neck, head, limbs and trunk

  • Gait freezing

  • Falls

  • Dysphagia (50% at 15 yr)42

  • Neuropsychiatric symptoms (50% at 15 yr),42 including hallucinations, sleep disturbance and dementia

  • Autonomic disturbances (70%–80%),43,44 including sweating, orthostasis, sialorrhea and urinary dysfunction

  • Seborrheic dermatitis (usually involving the forehead, with flaky oily skin)

  • Note: HR = hazard ratio, REM = rapid eye movement.

  • * The risk of synucleinopathy (i.e., Parkinson disease, multiple system atrophy, Lewy body dementia) in patients with REM sleep behaviour disorder was reported to be 30% at 3 years, rising to 66% at 7.5 years.45 Advanced age (HR 1.07), olfactory loss (HR 2.8), abnormal colour vision (HR 3.1), subtle motor dysfunction (HR 3.9) and nonuse of antidepressants (HR 3.5) identified higher risk of disease conversion.45