Objective: To reveal prodromal symptoms at a public seminar for PD via questionnaires.

Background: How to select subjects with PD for disease modify therapy in the prodromal state is our great concern. To date, the prevalence of prodromal symptoms in Japanese PD patients has not been clear.

Methods: Subjects were 207 PD patients and their caregivers. One questionnaire sheet was distributed per patient. The questionnaire asked about symptoms for distinguishing phenotypes and the presence and onset of hyposmia, constipation, RBD, hallucinations, forgetfulness, and etc in the prodromal state. By modifying the methods of J. Spiegel et al. (J Neural Transm, 2007, 114: 331), we calculated phenotypes according to the patients’ subjective symptoms. Patients were subdivided into tremor-dominant type (TDT), akinetic-rigid type (ART), and mixed type (MIT) groups.

Results: Ninety-four subjects answered questionnaires. Of those, we were unable to classify phenotypes in two subjects and therefore excluded them (male n = 51, female n = 37, undefined n = 4). The largest age and disease onset distribution were 70–79 years of age (n = 47, n = 36, respectively). In the prodromal state, approximately 50% of patients experienced constipation in any phenotype. It was a predominant prodromal symptom. The PD patients noted constipation issues during various periods. Though, comparing other symptoms, greater patients were aware of it more than 16 years prior to the onset of their motor symptoms. Additionally, 34.8% of TDT, 28.6% of ART, and 55.6% of MIT patients were aware of hyposmia, and 11.4% of those were aware more than 16 years prior to the onset of motor symptoms. However, none were aware more than 11 years prior to the motor symptoms in the TDT. 43.5% of TDT, 26.2% of ART, and 48.1% of MIT patients were aware of forgetfulness. The maximum distribution period of awareness was 0–5 years prior to the onset of motor symptoms. Other prodromal symptoms were observed in 10–30% of patients. When comparing other phenotypes, prodromal symptoms were frequently observed in the MIT. Those were seldom observed more than 11 years prior to the onset of motor symptoms in the TDT.

Conclusions: Our questionnaire indicated that Japanese PD patients were aware of various prodromal symptoms more than 16 years prior to the onset of motor symptoms, and the most common prodromal symptom was constipation. Prodromal symptoms and their onsets may vary, depending on the phenotype of PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/survey-of-prodromal-symptoms-of-parkinsons-disease-in-japan/