Deafness, epilepsy may be an early sign of Parkinson’s disease

Deafness and epilepsy were associated with a future diagnosis of Parkinson’s disease, an observational study of primary care records in East London showed.

Among ethnically diverse primary care patients, epilepsy (OR 2.5, 95% CI 1.63-3.83) and deafness (OR 1.66, 95% CI 1.06-2.58) were associated with subsequent diagnosis of Parkinson’s disease. , Dr. Alastair Neuss of Queen Mary reported.University of London, and co-author of JAMA Neurology..

Known symptoms associated with Parkinson’s disease, such as tremor and memory loss, were discovered in primary care records years before diagnosis. Tremors were seen up to 10 years ago (OR 11.66, 95% 6.59-20.64) and memory symptoms appeared 2-5 years before Parkinson’s disease was diagnosed (OR 3.08, 95% CI 1.81-5.24).

“People see symptomatic GPs, but often they aren’t diagnosed until the next 5-10 years,” Noyce said in a statement.

“For example, tremor is one of the most recognizable symptoms of Parkinson’s disease, but it was seen in our study 10 years before the final diagnosis,” he pointed out. “This is too long for the patient to wait.”

In the primary care setting, the symptoms that signal the onset of Parkinson’s disease were first discussed, and Obana Patel, DO, at the University of Florida, Gainesville, was observed. Ancillary editorial.. “But little is known about the prediagnostic symptoms of Parkinson’s disease in primary care clinics, especially in poorly serviced people,” they write.

“As neuroprotection and disease-modifying therapies become available for Parkinson’s disease, early identification and expert referrals will depend on primary care clinicians,” Patel and colleagues added.

Researchers conducted a nested case-control study using electronic health records from 1990 to February 2018 in primary care practice in East London. In total, 1,055 people diagnosed with Parkinson’s disease matched 10,550 controls.

In East London, 45% of residents are blacks, South Asians, or members of other ethnic groups. Overall, 80% of the survey participants came from low-income households.

Noyce and co-authors selected 24 exposures based on previous studies of prediagnosis signs and risk factors. “Epilepsy and deafness were included taking into account preliminary evidence that these may be pre-diagnostic features of Parkinson’s disease,” they said. Three periods of less than 2 years, 2 to less than 5 years, and 5 to 10 years before diagnosis were analyzed.

As expected, the researchers identified constipation, malaise, insomnia, dizziness, cognitive impairment, shoulder pain, and tremor as pre-diagnosis concerns for the Parkinson’s disease group.

They also found many markers included in the Parkinson’s disease study criteria: never smoke, type 2 diabetes, Parkinsonism, constipation, hypotension or dizziness, erectile dysfunction, depression, anxiety, and worldwide. Cognitive impairment.

Researchers have found no link between ethnic or economic deprivation and the diagnosis of Parkinson’s disease, in contrast to recent times. Reported about dementia..

Epilepsy was associated with subsequent Parkinson’s disease over all time frames assessed. Deafness was associated if it was identified as less than 2 years, or 2 to less than 5 years before the diagnosis of Parkinson’s disease.

“A new temporal link was observed for epilepsy and deafness and the subsequent onset of Parkinson’s disease,” Noyce and co-authors said.

Researchers performed replication analysis using case control data from UK Biobank The cohort found that epilepsy and deafness were again associated with a subsequent diagnosis of Parkinson’s disease over a three-period period. With the exception of hearing loss for a period close to the diagnosis of Parkinson’s disease, the OR for epilepsy was about 3 and the OR for hearing loss was about 1.2 (OR 1.03, 95% CI 0.69-1.52).

“There is new literature on the difficulty of auditory processing in Parkinson’s disease and the cognitive impairment of musical and non-verbal voice emotions,” writes Noyce and colleagues. “The role of early deafness requires further research, but this factor, as well as visual impairment, may represent another defect in sensory processing that occurs as part of the pathogenesis of Parkinson’s disease.”

“We believe our findings provide practical considerations that are potentially important to primary care physicians and opportunities to address patient concerns in the early stages of the illness,” they added. “This is not the case for asymptomatic disease screening, but it correctly identifies the root cause of patients who are symptomatic and may seek timely future referrals.”

The researchers admitted that the study had some limitations. Data are collected from regular primary care records and some signs of Parkinson’s disease may not be recorded. Parkinson’s disease may have been misdiagnosed and no information was known about the patient’s medications, including those that could lead to drug-induced Parkinsonism.