People with unrecognized Parkinson’s disease (PPD) experience mobility problems, muscle weakness, and struggles with other aspects of daily functioning up to three years before diagnosis, new study finds. shown.
The new findings come from a large case-control study that analyzed Medicare claims data to assess functional limitations in PPD and suggest that researchers should recognize PPD as a separate stage. suggesting.
Dr. Cameron Miller Patterson
“It’s becoming more and more recognized as a stage of Parkinson’s disease, and there’s some debate about it,” said Cameron Miller Patterson, MD, assistant professor of neurology and principal investigator at Virginia Commonwealth University in Richmond. Medscape Medical News“People with prodromal Parkinson’s disease may have functional limitations, so early identification and appropriate symptomatic treatment may be helpful.”
The survey results were published online on December 19th. Department of Neurology, JAMA.
Improving quality of life
PPD patients have symptoms of Parkinson’s disease, but not enough to meet diagnostic criteria. However, all her PPD patients eventually meet that threshold.
To assess whether functional limitations exist in prediagnostic PD patients and the general population, investigators studied 6674 people aged 65 years and older who participated in the National Health and Aging Trends Study (NHATS), a longitudinal study in the United States. We analyzed Medicare-related data. usa. Questionnaires assessed dexterity, eating, mobility, mood, pain, sleep, speech, strength, and vision.
Patients with incident PD were defined as having two or more Medicare diagnoses. Controls were defined as eligible for Medicare at baseline and not diagnosed more than 2 years ago.
Those who were eventually diagnosed were less likely to report being able to walk 6 blocks than those who had never had Parkinson’s disease (odds ratio [OR], 0.34; 95% CI, 0.15 – 0.82), kneeling and standing independently (OR, 0.30; 95% CI, 0.11 – 0.85), or lifting heavy overhead (OR, 0.36; 95% CI, 0.15 – 0.87). They were also more likely to report imbalance his 3 years before diagnosis (OR, 2.77; 95% CI, 1.24–6.20).
“Usually, we don’t start treating patients until they’ve been seen in a clinic and diagnosed with Parkinson’s disease,” Miller-Patterson said. can improve quality of life.”
provide better service to patients
Better awareness of PPD will also help identify clinical trial participants for treatments that may slow disease progression beyond the capabilities of currently approved drugs.
This, and the growing support for distinguishing PPD as a formal stage of PD, make these findings timely and important, write the authors of the accompanying commentary.
“Based on the argument that prodromal recognition may be too late to make meaningful clinical changes after symptoms have become clinical, given the extent of neurodegeneration that is already present, disease-modifying interventions have been proposed.” has been considered potentially important to the success of neuroscience. O. Bledsoe, MD, Weill Institute for Neurosciences, University of California, San Francisco, and co-authors.
However, one limitation is that this study design did not allow the investigators to determine whether eventual PD patients who reported Parkinson’s symptoms had prodromal PD or undiagnosed disease. The answer reveals whether prodromal PD is more common than previously thought, or whether the diagnosis of PD is often delayed by years, or both.
“Despite the limitations of this study, its broader point and importance remain the same. People appear to have some markers of functional decline before being diagnosed with PD,” said the editors. writing. “Furthermore, motor dysfunction may develop earlier than we normally think.There is a potential opportunity to better serve this population.”
This study was funded by the National Institutes of Health. Miller-Patterson reported that she received other NIH grants in the course of her research. Bledsoe reported individual fees from Boston Scientific, Amneal Pharmaceuticals, IDEO, Accorda, Humancraft.com, Putnam Associates, grants from the National Institutes of Health, the Michael J. Fox Foundation, and Dystonia Medical. Full disclosure is available in the original article.
Jama Neuro. Published online on December 19, 2022.
Kelli Whitlock Burton is a Medscape Medical News reporter covering neurology and psychiatry.
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