ENS 2009: First Signs of Parkinson's Often Not Motor-Related

Allison Gandey

July 01, 2009

July 1, 2009 (Milan, Italy) — Patients may have symptoms years before they experience the motor manifestations of Parkinson's disease, report experts. Presenting here at the 19th Meeting of the European Neurological Society, researchers emphasized that an array of seemingly unrelated symptoms may actually be the first signs of Parkinson's.

"Evidence is accumulating from clinical, neuroimaging, and pathological studies that olfactory dysfunction, dysautonomia, or mood and sleep disorders can occur years and perhaps even decades before the classical motor symptoms arise," Eduardo Tolosa, MD, from the University of Barcelona, in Spain, said at the meeting.

"These data suggest that, at least in some cases, Parkinson's disease may start in the lower brain stem, olfactory structures, or the peripheral autonomic plexuses, reaching the substantia nigra only later," he noted. "It is unclear when these structures become involved in the neurodegenerative process."

Although Parkinson’s disease is most common in elderly patients, some may be affected in their 40s or even younger. Claudio Bassetti, MD, from the University Hospital of Zurich, in Switzerland, voiced concern about doctors relying too heavily on dopaminergic medications.

"We increasingly notice that some patients with Parkinson's disease and restless-legs syndrome take more dopamine than they really need to," he said. "The involvement of the dopamine system in reward mechanisms and eventually in the neurobiology of addiction may explain this overuse."

Dr. Bassetti and his research team studied sleep walking in patients with Parkinson's disease. Using a questionnaire, they asked 417 patients about their sleep quality and sleep disorders.

Sleep Walking, Compulsive Behavior, and Suicide

Dr. Bassetti's group found that patients with Parkinson's disease were more likely to sleep walk and experience other sleep disturbances. In all, 9% of patients reported sleep walking. These patients had significantly longer disease duration (P = .035) and were more likely to have hallucinations and nightmares (P = .004 and P = .003).

Sleep walking, the researchers suggest, appears to be a late manifestation of Parkinson's disease.

According to presenters, there is also increasing awareness about compulsive behavior in some patients with Parkinson's disease. "These impulse-control disorders such as pathological gambling, hypersexuality, compulsive shopping, compulsive eating, or compulsive overuse of dopaminergic drugs can lead to monetary losses or worsen the social handicap of Parkinson's patients," Dr. Bassetti added in a news release.

"It is necessary to consider pathological gambling in young Parkinson's disease patients with regard to their treatment and possible clinical and sociological outcomes," conclude researchers from the University of Brno, in the Czech Republic.

Their small study compared 20 patients and 20 controls using a computerized version of the Iowa Gambling Task. They found that Parkinson's patients had significantly lower scores and were more likely to make bad choices.

Another study, from the Institute of Neurology in Belgrade, Serbia, explored the risk for suicide in patients with Parkinson's disease. Investigators followed 102 patients for 8 years. They found that suicide-specific mortality was more than 5 times higher (95% CI, 2.1 – 12.7). In all, almost a quarter of the Parkinson's patients either died or experienced suicidal ideation, which may significantly influence quality of life.

"Nonmotor manifestations of Parkinson's disease are an important new challenge and increasingly recognized as an important feature in the diagnosis and treatment of this disorder," Dr. Bassetti said.

The researchers have disclosed no relevant financial relationships.

19th Meeting of the European Neurological Society: Abstracts 17, O38, O39, P408. Presented June 20-24, 2009.

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