OBJECTIVE: To study inaugural symptom(s) in parkisonism (PS) of various etiologies from the Lausanne Movement Disorders Registry (LMDR).
BACKGROUND: Inaugural symptom(s) may provide some information about early diagnosis in PS.
DESIGN/METHODS: Prospective study of inaugural symptom(s)(spontaneous report and suggested) in clinically-diagnosed PS.
RESULTS: 1066 patients with PS from the LMDR were studied: 333 Parkinson's diseases (PD) (31%); 215 multiple system atrophies (MSA)(20%)[165 nigrostriate degenerations (NSD), 10 Shy- Drager syndromes (SDS) and 40 olivo-ponto-cerebellar atrophies (OPCA)]; 204 PS and dementia (PDD) (19%); 61 progressive supranuclear palsies (PSP)(6%); 59 PS of various causes (PDV)(5%); 59 familial PS (F-PS)(5%); 53 drug-induced PS (DIP)(5%); 46 almost pure tremulous PD (T-PD) (4%); 20 cortico-baso-ganglionic degenerations (CBGD) (2%) and 16 early-onset PD (E-PD)(1%). Tremor was the most frequent initial symptom in PS (34%): 86 % in T-PD, 46% in PD, 40% in F-PD, 32% in PDD, but only second in SND (21%) and E-PD (25%) and less frequent elsewhere. Inaugural gait symptoms (17%) were second in frequency, but first in OPCA (72%), PSP (46%), PDV (30%) and SND (24%) and second in PDD (14%). Initial slowness (17%), stiffness (8%), depression (5%), pain (5%), fatigue (4%), psychosis (4%), cognitive dysfunction (3%), dysautonomia (2%), micrographia (1%), amimia(1%)were less frequent. Obsessive traits (OT) were only found in PD (70%) and SND (20%). Sleep problems were initial in SDS only. Inaugural pain was first in E-PD (38%) and CBGD (30%), and inaugural psychosis in DIP (58%) and PDD(5%). Significant (p=0.05) correlations between initial symptoms and diagnosis were found for tremor in T-PD only, for gait in PSP, MSA (OPCA and SND), for slowness in E-PD and DIPD, for stiffness in F-PD and PD, for pain in E-PD (trend in CBGD), for dysautonomia in MSA (p<0.02 in SDS), for cognitive dysfunction in PDD, for dysarthria in PSP, for dystonia in E-PD(trend in F-PD), and for OT in PD and MSA.
CONCLUSIONS: Inaugural tremor, the major first symptom in PS has no significant correlation with any diagnosis except T-PD. Gait problems, the second most frequent inaugural symptom, are only significantly correlated with PSP. Initial pain, slowness, dystonia and micrographia had significant correlation with E-PD, inaugural dysarthria with PSP, cognitive dysfunction with PDD, psychosis with DIP and PDD and dysautonomia with MSA, especially SDS. OT were only found in PD and MSA.