Objective: To investigate whether the predominant initial PD motor symptom is associated with gender or age of onset of PD in Sri Lanka.

Background: Studies in the western world have shown significant variation in the type of predominant initial motor symptom, with age of onset of Parkinson’s disease (PD). The basis for these variations is unknown.

Methods: Clinical and demographic data was collected from a random cohort of 254 patients with parkinsonism attending neurology clinics in Colombo, Sri Lanka. 142 patients fulfilled UK PD Society Brain Bank Clinical Diagnostic Criteria for Idiopathic PD. Clinical data collected included age of symptom onset, initial predominant motor symptom and side (left/right) of onset of specific symptoms. Age of onset was divided into 2 groups : young (≤ 49 years) and old (≥50 years).

Results: This study included 86 male and 56 female patients, with no significant difference in age of onset of PD between genders (56.6±9.5). The initial symptom included tremor (109 patients, 76.7%), bradykinesia (19 patients, 13.4%), rigidity (7 patients, 4.9%) and postural instability (7 patients, 4.9%) and was categorized as tremor versus non-tremor (bradykinesia, rigidity, postural instability) for all analyses. Females were 3 times more likely to develop tremor as the initial symptom compared to males (OR 3.03; CI-1.21-7.58, p=0.0176). There was no significant correlation between the side of tremor onset and gender (OR 1.64, 95% CI 0.74 – 3.656; p=0.222). Patients developing PD at an older age (≥age 50) were 2.8 times more likely to develop tremor as a first symptom compared to those of young age of onset (≤ age 49, 23.6 %) (OR 2.8; 95% CI 1.2 – 6.62; p=0.014).

Conclusions: This Sri Lankan study shows that females are more likely to exhibit tremor as the initial symptom of PD compared to males. Older patients more often showed tremor as a first symptom as compared to younger patients. These findings are consistent with results from Western studies, suggesting common underlying disease mechanisms in Western and South Asian populations. Longitudinal follow up and investigating associations of these findings with genetic and environmental factors will aid in further understanding the basis for clinical heterogeneity in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-initial-motor-symptom-of-parkinsons-disease-in-relation-to-age-at-onset-and-gender-a-sri-lankan-perspective/