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. 2014 Mar 27;9(3):e92878.
doi: 10.1371/journal.pone.0092878. eCollection 2014.

Mild Parkinsonian Signs in the Elderly--Is There an Association With PD? Crossectional Findings in 992 Individuals

Free PMC article

Mild Parkinsonian Signs in the Elderly--Is There an Association With PD? Crossectional Findings in 992 Individuals

Stefanie Lerche et al. PLoS One. .
Free PMC article


Background: Mild parkinsonian signs (MPS) are common in the elderly population, and have been associated with vascular diseases, mild cognitive impairment and dementia; however their relation to Parkinson's disease (PD) is unclear. Hypothesizing that individuals with MPS may reflect a pre-stage of PD, i.e. a stage in which the nigrostriatal system is already affected although to a milder degree than at the time of PD diagnosis, aim of this study was to evaluate the similarities between MPS and PD.

Methods: The TREND study is a prospective cross-sectional cohort study in individuals >50 years with biennial assessments designed to identify markers for an earlier diagnosis of Parkinson's and Alzheimer's disease. For this substudy 992 individuals were included for analyses (892 controls, 73 MPS individuals, 27 PD patients). Parameters defining risk of PD (sex, age, positive family history), prodromal markers (hyposmia, REM sleep behavior disorder, depression and autonomic failure) as well as quantitative fine motor, axial motor and cognitive parameters were compared between the three cohorts.

Results: As expected, PD patients differed from controls with regard to 12 of 15 of the assessed parameters. MPS individuals differed significantly from controls in 12 of the PD-associated parameters, but differed from PD only in 5 parameters.

Conclusion: This study shows that individuals with MPS share many prodromal and clinical markers of PD with PD patients, implying that either a common dynamic process or similar constitutional factors occur in MPS individuals and PD patients.

Conflict of interest statement

Competing Interests: Dr. Lerche, Mr. Hobert, Ms. Wurster, Dr. Gaenslen and Ms. Hasmann reports no disclosures. Dr. Brockmann has received honoraria for lectures from the Deutsche Gesellschaft für klinische Neurophysiologie (DGKN) as well as travel grants from GlaxoSmithKline, UCB and the Movement Disorders Society. Prof. Maetzler has received speaker honoraria from GlaxoSmithKline, and receives research support from the European Union and the Robert Bosch Foundation. Prof. Eschweiler has received grants for Phase II and phase III study in alzheimer disorders from AC Immune and Janssen Alzheimer Immunotherapy Research. Prof. Berg has received Advisory Boards from UCB SchwarzPharma, Novartis, Merz; Honoraria from UCB SchwarzPharma, GSK, TEVA, Lundbeck; Grants from Michael J Fox Foundation, BmBF, Janssen Pharmaceutica, TEVA Pharma GmbH, Böhringer, dPV (German Parkinson's disease association), Abbott and Center of Integrative Neurosciences. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.


Figure 1
Figure 1. Trail Making test and Purdue PegBoard test results of Controls, individuals with MPS and Parkinson.
A) TMT part A. B) TMT part B. C) delta TMT B-A. PD patients were slower in all three TMT tasks compared with controls. Individuals with MPS need more time for completion of TMT part B and in delta TMT B-A than controls but do not differ in the easier TMT part A. In the more complex tasks (B+C) PD patients and individuals with MPS perform similar. D) sumscore of single right hand, single left hand and both hands: In the quantitative fine motor task individuals with MPS as well as PD patients, perform slower than controls. MPS, Mild Parkinsonian Signs; PD, Parkinson's Disease; TMT, Trail Making Test. *: p<0.05; **: p<0.01
Figure 2
Figure 2. Dual task results of Controls, individuals with MPS and Parkinson's disease.
Individuals with MPS and PD patients walk slower and check fewer boxes under dual task conditions compared to controls. There is no speed difference between PD patients and individuals with MPS. MPS, Mild Parkinsonian Signs; PD, Parkinson's Disease *: p<0.05; **: p<0.01
Figure 3
Figure 3. Evaluated risk factors, premotor markers and early motor symptoms in a model, based on the hypothesis of Braak et al. .
MPS, Mild Parkinsonian Signs

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Grant support

This analysis of the TREND study was financially supported by a grant of UCB. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.