Diagnosis and the premotor phase of Parkinson disease

• Published in: Neurology Vol. 72; no. 7 Suppl; pp. S12 - S20
• Main Authors: Tolosa, Eduardo, Gaig, Carles, Santamaría, Joan, Compta, Yaroslau
• Format: Journal Article
• Language: English
• Published: United States 17-02-2009
• Subjects: Early Diagnosis; Humans; Mood Disorders - physiopathology; Olfaction Disorders - physiopathology; Parkinson Disease - diagnosis; Parkinson Disease - physiopathology; Primary Dysautonomias - physiopathology; Sleep Wake Disorders - genetics; Sleep Wake Disorders - physiopathology
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/wnl.0b013e318198db11

Clinical, neuroimaging, and pathologic studies have provided data suggesting that a variety of nonmotor symptoms can precede the classic motor features of Parkinson disease (PD) by years and, perhaps, even decades. The period when these symptoms arise can be referred to as the "premotor phase" of the disease. Here, we review the evidence supporting the occurrence of olfactory dysfunction, dysautonomia, and mood and sleep disorders, in this premotor phase of PD. These symptoms are well known in established PD and when presenting early, in the premotor phase, should be potentially considered as an integral part of the disease process. Even though information on the premotor phase of PD is rapidly accumulating, the diagnosis of premotor PD remains elusive at this time. Should a safe and effective treatment with disease-modifying or neuroprotective potential in PD become available, identifying individuals in the premotor phase will become a serious priority.