Which nonmotor symptoms precede the motor signs of Parkinson disease (PD)?

Updated: Aug 29, 2019
  • Author: Robert A Hauser, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Some nonmotor symptoms commonly precede motor signs in Parkinson disease. Most Parkinson disease patients have a substantial reduction in olfactory function (smell) by the time motor signs emerge. However, either this is not noticed by the patients or patients may not realize that it is part of the disease. Another common premotor symptom is rapid eye movement (REM) behavior disorder (RBD). In this condition, individuals exhibit movements during REM sleep that are often described as hitting or kicking motions. There are also a number of midlife risk factors for the later development of Parkinson disease. These include constipation and excessive daytime sleepiness, although they are far from specific for Parkinson disease.

In a British study, the frequency of nonmotor symptoms in 159 patients with newly diagnosed Parkinson’s disease was found to be significantly greater than that in 99 healthy age-matched control patients (mean, 8.4 vs 2.8). [24] The most commonly experienced nonmotor symptoms in patients with early Parkinson disease in this study included the following [25] :

  • Excessive saliva

  • Forgetfulness

  • Urinary urgency

  • Hyposmia

  • Constipation

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