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NEUROLOGY 2009;72:S12-S20
© 2009 American Academy of Neurology

Diagnosis and the premotor phase of Parkinson disease

Eduardo Tolosa, MD, Carles Gaig, MD, Joan Santamaría, MD and Yaroslau Compta, MD

From the Parkinson's Disease and Movement Disorders Unit, Institut Clínic de Neurosciències, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona; and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Spain.

Address correspondence and reprint requests to Eduardo Tolosa, MD, Parkinson's Disease and Movement Disorders Unit, Institut Clínic de Neurosciències, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona, Villarroel 170, Barcelona 08036, Spain etolosa{at}clinic.ub.es

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.

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Disclosure: E. Tolosa has received honoraria from Teva and Lundbeck, as well as other companies in the Parkinson disease field. The other authors state that they have no financial or nonfinancial conflicts.

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