First Neurological Evaluation And Course Of Parkinson'S Disease

Objective: To determine the significance of clinical motor findings at first neurological evaluation to the prognosis in PD.Background: Non-motor features may precede motor symptoms of Parkinson’s disease (PD). The diagnosis is however based on a combination of bradykinesia (akinesia), rigidity and tremor. When the diagnosis of PD is made by a neurologist the patient wants pertinent information including the expected outcome, which has major significance to the individual/family. It is well known that patients with akinetic-rigid phenotype have the worst and tremor dominant cases the best outcome. However, an individual patient’s phenotype can change over time.Methods: Patients evaluated at Movement Disorders Clinic Saskatchewan (MDCS) are offered autopsy at no cost. We have previously reported on the course of different lifelong motor phenotypes in 166 autopsied PD cases. For this study, we identified the severity of motor features at initial MDCS assessment to determine its value in predicting the prognostic phenotypes in that group. Those with motor symptoms of 15 years or longer duration at first visit were excluded from this study.Results: 156 (98 M) autopsy confirmed PD - 39 (25[percnt]) akinetic-rigid, 106 (68[percnt]) mixed and 11 (7[percnt]) tremor dominant cases had satisfactory clinical baseline data on bradykinesia, rigidity and tremor. Of those cases 70 (45[percnt]) were not on any anti-parkinsonian drugs at initial evaluation. The baseline motor features in 156 cases positively predicted the phenotype in 85[percnt] of all - 90[percnt] of akinetic-rigid, 88[percnt] of the mixed, but in only 55[percnt] of the tremor dominant cases. In the 70 untreated cases, the lifelong phenotyping could be predicted at baseline in 91[percnt] patients.Conclusions: Our data show that initial neurological assessment can provide a valuable guide to the course of disease in most PD cases. Such cases can be used for future research to identify reliable prognostic biomarkers. Disclosure: Dr. Rajput has nothing to disclose. Dr. Rajput has nothing to disclose. Dr. Ferguson has nothing to disclose. Dr. Rajput has nothing to disclose.