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Early Signs May Precede Parkinson’s Disease Diagnosis by Six Years

Neurology Reviews. 2016 June;24(6):25-27



Suggested Readings
Arnulf I, Neutel D, Herlin B, et al. Sleepiness in idiopathic REM sleep behavior disorder and Parkinson disease. Sleep. 2015;38(10):1529-1535.
Beavan M, McNeill A, Proukakis C, et al. Evolution of prodromal clinical markers of Parkinson disease in a GBA mutation-positive cohort. JAMA Neurol. 2015;72(2):201-208.
Schrag A, Horsfall L, Walters K, et al. Prediagnostic presentations of Parkinson’s disease in primary care: a case-control study. Lancet Neurol. 2015;14(1):57-64.

VANCOUVER—Patients may have impairments in their daily activities six years before they receive a diagnosis of Parkinson’s disease, according to an analysis presented at the 68th Annual Meeting of the American Academy of Neurology. These problems typically involve instrumental activities, which require motor and nonmotor skills. Subtle motor and cognitive deficits also may be observable six years before diagnosis. As the time of diagnosis approaches, additional motor symptoms arise, and patients report symptoms of anxiety and depression more frequently than people who do not develop Parkinson’s disease, said Sirwan Darweesh, MD, of the Erasmus MC University Medical Center in Rotterdam, the Netherlands. In addition, patients’ problems in daily functioning begin to affect basic activities.

Sirwan Darweesh, MD

A Prospective, Population-Based Study

Among researchers, interest in defining earlier stages of Parkinson’s disease is increasing, under the assumption that it may enable effective neuroprotection. Dr. Darweesh and colleagues conducted a nested case–control study within the population-based Rotterdam Study. The latter study was initiated in 1990 among inhabitants of a district of Rotterdam. All persons age 55 or older were invited to participate. Dr. Darweesh and colleagues excluded people with Parkinson’s disease at the time of enrollment from their analyses.

Approximately 8,000 people (about 80% of the eligible population) participated in the study. Individuals who did not participate tended to be slightly older and to have more locomotor diseases and more cardiovascular diseases.

At baseline, participants underwent a battery of assessments for potential prediagnostic features of Parkinson’s disease. The tests represented the three broad categories of activities of daily living, motor features, and nonmotor features. The investigators also assessed symptoms of depression and anxiety with the Center for Epidemiologic Studies Depression Scale and the Hospital Anxiety and Depression Scale. These assessments were repeated every four years.

In addition, the researchers evaluated whether participants had developed Parkinson’s disease during follow-up. Research physicians conducted repeated in person examinations and had complete access to participants’ medical files, which included diagnostic codes, specialist letters, and free text entries by neurologists and other physicians.

To identify differences between prediagnostic patients with Parkinson’s disease and controls, Dr. Darweesh and colleagues matched every person with incident Parkinson’s disease with 15 controls, based on age and sex. They analyzed the data to determine when prediagnostic features differed significantly between cases and controls during the prediagnostic period. In all, 107 people (approximately 50% women) developed incident Parkinson’s disease at a mean age of 77.

Movement and Postural Problems Emerged

At six years before Parkinson’s disease diagnosis, prediagnostic patients reported problems with daily activities, specifically instrumental activities such as traveling, more frequently than controls did. At about three years before diagnosis, problems in daily functioning extended to basic tasks such as eating, said Dr. Darweesh.

At about five to six years before diagnosis, prediagnostic patients showed signs of hypokinesia, bradykinesia, or tremor more frequently than controls did. In the last few years before diagnosis, patients also showed signs of cogwheel rigidity, postural abnormality, and postural imbalance more frequently than controls did.

When the investigators examined nonmotor features, they found that at about five years before diagnosis, patients with Parkinson’s disease already had significantly lower Mini-Mental State Examination scores than controls did. In the years before diagnosis, patients were also more likely to report anxiety symptoms and depressive symptoms than controls were. During follow-up, the researchers found that patients with Parkinson’s disease used laxatives more frequently than controls did, although differences only became significant in the last few years before diagnosis. “We believe that these data add important information to our knowledge of prediagnostic Parkinson’s disease,” said Dr. Darweesh. “We hope that these data can contribute to a better understanding of how to define earlier stages of this disease.”

Erik Greb


Suggested Readings
Arnulf I, Neutel D, Herlin B, et al. Sleepiness in idiopathic REM sleep behavior disorder and Parkinson disease. Sleep. 2015;38(10):1529-1535.
Beavan M, McNeill A, Proukakis C, et al. Evolution of prodromal clinical markers of Parkinson disease in a GBA mutation-positive cohort. JAMA Neurol. 2015;72(2):201-208.
Schrag A, Horsfall L, Walters K, et al. Prediagnostic presentations of Parkinson’s disease in primary care: a case-control study. Lancet Neurol. 2015;14(1):57-64.

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Study Guide Ch 4

Chabner, Language of Medicine 8th Edition, Ch 4 Prefixes

intracostalpertaining to – between the ribs (-al = pertaining to, intra- = between, cost/o = ribs)
contralateralpertaining to the opposite side (-al = pertaining to)
exophthalamosprotrusion of an eyeball
syndactylya congenital anomaly (congenital = present at birth)
parasitism is an example of … ?symbiosis
symptoms precede an illness (like a fever, or rash)prodrome
before mealsante cibum
antibodiesprotein substances made by leukocytes (anti- = against)
symphysisbones grow together, as in the pelvis
ultrasonographysound waves and echoes are used to create an image
metamorphosischange in shape or form
hypertrophyincrease in cell size, increased development (-trophy = development)
hyperglycemiaexcessive sugar in the blood
retroperitonealbehind the abdomen (retro- = back, behind) (peri = around, surrounding)
streptococci is an example of an …?antigen
return of disease symptomsrelapse
dia-complete, through (as in Diagnosis)
abductor muscleAb (b faces away) carries a limb AWAY from the body
adductor muscleAd (d faces toward) pulls limb TOWARD the body.
dyspneadifficult breathing (pnea = breathing, dys- = difficult)
Tachycardiarapid heartbeat (cardia = heartbeat, tachy- = rapid or fast)
parathyroid glandslocated on the dorsal side of an endocrine gland in the neck (the thyroid gland) para = near
Recombinant DNAgene from one organism is inserted (recombined) into another organism
epitheliumSkin cells. Surface cells that line internal organs and found in the skin.
percutaneousthrough the skin
anoxiacondition of no oxygen
antisepsisagainst infection
congenital anomalyirregularity present at birth (such as … born with webbed toes)
antepartumbefore birth
apneanot breathing
contralateralpertaining to opposite side
metamorphosiscondition of change of shape or form
malaisevague feeling of bodily discomfort
pancytopeniadeficiency of ALL blood cells
metasasisspread of a cancerous tumor to a secondary organ or tissue
exophthalmoseyeballs that bulge outward
paralysisloss of movement in muscles
prodromesymptoms that appear before an illness (such as a rash or fever)
remissionsymptoms lessen
relapsedisease or symptoms return
webbed fingers or toessyndactyly
neoplasmnew growth (tumor)
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    Medical Terminology

    Medical Definitions and Word Differences

    What is the medical term meaning symptoms that precede the illness?

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    What is the medical term for a person educated in caring for the terminally ill?

    It is called “hospice care” where terminally ill individuals can receive care within their own home. Typically, individuals who work within this field are nurses, and social workers.

    What does padable mean in medical terms?

    Padable is not a word related to the medical field. However,palpable is. When referring to the word palpable you are referringto touch or being able to feel.

    What is the medical term meaning bloody?

    Sanguinous is the medical term meaning bloody. Hemorrhagic means pertaining to excess flow of blood.

    What is the medical term meaning fart?

    ANSWER: .
    Flatulence. See the related link for more information. Flatulence is the condition of farting. The gas that comes out is flatus. Flatulence, Flatus

    What is the Medical term meaning farsighted?

    Hyperopic is the medical term meaning far-sighted. Presbyopic often results in difficulty with close vision, but it refers specifically to changes in vision with advanced age.

    What is the medical term meaning symptoms that occur before the true onset of the disease?

    PROGNOSIS is the answer you are looking for. I found the answer inmy Medical Terminology textbook.

    What is the medical term meaning ‘this medical emergency’?

    An emergency situation is called a crisis ; an affected individual is a casualty .

    What does subjective symptom mean in medical terms?

    subjective simply means that it is a symptom that is only apperent to the patient. It isn’t observable by anyone else. The oposite would be Objective, such as, “the patient is pale” while subjective is ‘I have a pain in my head’ When only one person can observe something it is subjective.

    What is the medical term meaning crippling inflammation of the joints is a symptom of the autoummune disease?

    The main disease that has a crippling effect on the joints is rheumatoid arthritis . Other conditions such as lupus, psoriasis, Ankylosing spondylitis and other autoimmune conditions can also cause crippling inflammation in joints.

    What is the medical term meaning seasickness?

    Motion Sickness, which is caused by a discordance between thestillness that your eyes see inside the boat and the motion yourinner ear feels.

    What does the medical term stats mean?

    Statistics. If it is stat instead of stats, then it means to do immediately, without delay, or urgently.

    What is the medical term meaning hunchback?

    Kyphosis is the medical term meaning an abnormal hump in the upper part of the back. kyph/o kyphosis

    What is the medical term meaning passed out?

    Losing consciousness ” Syncope ” is the correct medical term for passing out or blacking out, meaning a temporary loss of consciousness

    What is the medical term meaning with?

    In medical terms, with is often written as a lower case “c” with a horizontal line over it.

    What is the medical term meaning epicardium?

    Epicardium is the medical term (meaning the inner serous layer of the pericardium, lying directly upon the heart).

    What is the medical term meaning ear?

    Auricle is the medical term for the outer ear. The part you see on the outside is the auricle. Auricle auris The medical term for ear is auricle, though I have never heard anyone use that term outside of anatomy lab.

    What is the medical term meaning flu?

    “Flu” is an abbreviation for Influenza, a family of virus’s that are responsible for some viral infections.

    What does prone mean In medical terms?

    Prone means front side down, and usually refers to laying down. “The cat was laying prone on his chest”.

    What is the medical term meaning bent?

    Ankylosed is the medical term meaning abnormally bent; flexed is the medical term meaning normal bending of a joint.

    What is the medical term meaning tiredness?

    The medical term for tiredness is Somnolence if someone is sleepy, or fatigue if someone has a lack of energy.

    What is the medical term meaning abdomen?

    Abdomen Abdominal, however the abdomen are divided into nine regions : .
    epigastric .
    right hypocondriac .
    left hypocondriac .
    right lumbar .
    umbilical .
    left lumbar .
    right iliac .
    hypogastric .
    left iliac

    What is the medical term meaning blood?

    “haem” is the medical term of blood. for example, hemoglobins are blood cell particles. and bleeding is Hemorrhage

    What does Olympus mean in medical terms?

    The most common use of “olympus” in medical terms is the mnemonic used to remember the names of the cranial nerves. The mnemonic is, “On old Olympus’ towering top, a Finn and German viewed some hops.” Olympus represents cranial nerve III, the oculomotor nerve.

    What does the medical term systemic mean?

    Systemic means relating to or spread throughout and affecting a group, system, or body as a whole.

    What is the medical term meaning heat?

    Calor is the classic medical term meaning heat. It’s one of the four signs of inflammation (rubor, dolor, calor, tumor — redness, pain, heat, swelling).

    What does the medical term dragon mean?

    Cannot locate any medical usage for ‘dragon’. However, there is a medical term called ‘dracontiasis’ which is a variation of the word ‘dracunculiasis’which is an infestation disease caused by the guinea worm that has been eradicated in many regions but not in Africa; also called guinea worm disea (MORE)

    What does the medical term ante mean?

    Before, forward.
    Antecubital (before elbow); anteflexion (forward bending).
    a prefix meaning ‘before in time or in place’: anteflexion, antepartal.

    What is the medical term meaning by mouth?

    The Latin term used in medicine is ” per os ” which means literally “by mouth”. It is usually abbreviated as PO or p.o. Other medical terms used for by mouth are: orally, oral administration, and simply: by mouth. A related term, NPO, stands for “nil per os” which means “nothing by mouth”. T (MORE)

    Medical term for creating false symptoms to avoid work?

    The word is to malinger . A person who feigns illness or false symptoms is called a malingerer.

    What is the medical term meaning thumb?

    In medical terminology, the thumb is called a “pollex” from theLatin pollere, which means to be strong. It can also be called thedigitus (manus) primus [I] or “first finger”. its called the “pollex” or “1st finger” Its latin name and the name used in anatomy (when we can bebothered to be accurate) i (MORE)

    What does enzyme mean in medical terms?

    Merriam-Webster defines enzyme as: any of numerous complex proteins that are produced by living cells and catalyze specific biochemical reactions at body temperatures.

    What is the medical term meaning extremities?

    The medical term extremities means the farthest point or portion of – such as a limb

    What is the medical term meaning cervicoparavertebral?

    The correct medical term is: ‘cervical paravertebral’. A ‘cervical paravertebral block’ is an anesthetic approach used for surgery of the shoulder region; anesthetizing the neck (cervical) and along the spine (paravertebral).

    What is the medical term meaning eardrum?

    The tympanic membrane is called the eardrum. The medical term is tympanic membrane. tympanic membrane, or TM

    What is the medical term meaning nostril?

    Naris is the medical term meaning nostril. The plural is nares, and it rhymes with carries. A related body part, the nasal alae (singular nasal ala) is the side of the nostril – the part that moves if you “flare your nostrils.”

    What does trauma mean in medical terms?

    Two meanings, one physical and one emotional. A physical trauma is an injury, i.e., a “blunt force trauma to the head” might be caused by a bat to the head. There are mental traumas, such as being in war, the stress of which can cause Post Traumatic Stress Disorder, the trauma being that one had to (MORE)

    What is the medical term meaning stiffness?

    Many common forms of stiffness, hardness, or induration of soft tissue are called sclerosis. Sclerotic tissue is stiff or hard tissue. Examples: arteriosclerosis, atherosclerosis, cerebrosclerosis, scleroderma, multiple sclerosis (MS). Stiffness or immobility of the joints is called ankylosis. (MORE)

    What does last Illness means in legal terms?

    It would depend entirely on what the circumstances were of the situation in which it was applied. “Last Illness” is a fungible term which could mean several different things; (e.g.: the illness from which the deceased died – the last illness suffered prior to the current illness – etc). More would h (MORE)

    What does the medical term duction mean?

    Duction can be reduced further to “duct” by removing its suffix and generally refers to leading, guiding, piping, bringing, carrying, conveying, transporting, drawing along or out. “Duction” is most often used with a prefix such as re-, intro-, in-; i.e., introduction, induction, reduction. By itsel (MORE)

    What is the medical term meaning factor in a patient’s condition which makes the use of a drug dangerous or ill-advised?

    Contraindication -is a factor in which the patient’s condition that makes the use of a medication or specific treatment dangerous or ill advised.

    What is the medical term meaning symptoms of disease disappear?

    palliative describes treatment aimed at easing symptoms without curing. Remission is the term meaning disappearance of symptoms

    What is the medical term meaning return of symptoms of disease?

    Relapse is the return of disease symptoms. Exacerbation is a worsening of symptoms, and remission is the lessening of symptoms. relapse

    What is the medical term meaning illness without known cause?

    Idiopathic means without known cause. The medical term meaning ‘without a known cause’ is Idiopathic. Idiopathic Idiopathic Idiopathic

    What is the medical term meaning Medications given to relieve symptoms but do not cure the disease?

    Palliative medications relieve symptoms but do not cure diseases. vaccines Palliative care provides symptom relief without curing the problem.

    What is the medical term meaning a peculiar sensation appearing before more definite symptoms?

    In medical terminology, this is what is known as aura, prodome, or set of ‘prodromal symptoms’. Aura is a term used to describe peculiar symptoms that may appear before more definite symptoms of a disease or disorder such as Epilepsy or Migraine.

    Why use medical terms when they relate to diseases or symptom?

    Medical terminology is used under these circumstances because they are (usually and ideally) very exact, whereas modern parlance is not. For instance, a “Cold” in conversational English could refer to over 1,000 different medical conditions, some of which are entirely unrelated. As your treatment i (MORE)

    What is the medical term meaning psychological disorder that is a symptom of bodily disease?

    An organic mental disorder or organic mental illness is one that is caused by bodily disease. For instance, syphilitic insanity is an organic mental disorder.

    What is the meaning of the term backboard in medical terms?

    Backboards are used in triage by medical personel to provide a straight flat surface to put a patient on in order to move and treat them while they are physically secure and straight.

    What is the medical term for the symptom ringing in the ears?

    The medical term for the symptom, ringing in the ears is Tinnitus. Tinnitus affects about 1 out of every 5 people. It is not necessarily a symptom of something seriously wrong.

    What does the term precedent means?

    In law, a legal precedent is the principle in which a previouscase’s ruling takes considerable influence on the ruling of anysubsequent similar cases.


    What is the medical term meaning symptoms that precede the illness?

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