Early-onset Parkinson's disease and depression Doença de Parkinson de início precoce e depressão

Patients with Parkinson’s disease (PD) in whom symptoms start before the age of 45 years (EOPD) present different clinical characteristics from those with the late-onset form of the disease. The incidence of depression is believed to be greater in patients with EOPD than with the late-onset form of the disease, although there is no risk factor or marker for depression in patients with PD. We studied 45 patients with EOPD to define the frequency of depression and to identify possible differences between the groups with and without depression. Depression was diagnosed in 16 (35.5%) of the patients, a higher incidence than in the population at large but similar to the figure for late-onset Parkinson disease; 8 (50%) of the patients had mild depression, 4 (25%) moderate depression and 4 (25%) were in remission. There was no relationship between depression and any of the clinical characteristics of the disease, although the EOPD patients with depression presented earlier levodopa-related complications and were more affected on the Hoehn-Yahr, UPDRS and Schwab-England scales.Os pacientes com doença de Parkinson (DP) cujo início dos sintomas ocorre até os 45 anos (DPIP), apresentam características clínicas que a diferem da doença de início tardio. Estudos têm sugerido que pacientes com DPIP têm maior incidência de depressão quando comparados aos de início tardio, mas sem definição de algum marcador específico da doença para depressão. Estudamos 45 pacientes com DPIP, para definir a freqüência da depressão e verificar possíveis diferenças entre os grupos com e sem depressão. A depressão foi diagnosticada em 16 (35.5%) pacientes estando acima da média da população geral, porém semelhante aos índices relatados pelos estudos de pacientes com DP de início tardio; 8 (50%) pacientes tinham depressão leve, 4 (25%) moderada e 4 (25%) estavam em remissão.Não houve relação da depressão com nenhuma das características clínicas da doença, embora apresentem complicações mais precoces da levodopaterapia, e sejam mais afetados nas escalas de Hoehn-Yahr, UPDRS e Schwab-England

Unusual motor and non-motor symptoms and signs in the early stage of Parkinson’s disease

ABSTRACT Objective Patients with Parkinson’s disease (PD) may present with unusual motor and non-motor symptoms and signs in the early stage of the disease. Methods Cases were collected over a five-year period at two tertiary movement disorders clinics. All had a diagnosis of PD with unusual presentations defined retrospectively as the presence of complaints not objectively related to any of the classic cardinal signs of parkinsonism or the typical early non-motor features of PD. Results A total of 15 early PD patients fulfilled the proposed criteria, presenting with symptoms such as atypical tremors, shoulder pain, signs related to the rigid akinetic syndrome, as well as cases of asthenia, rhinorrhea, parosmia, dysgeusia, nocturnal sialorrhea, and color discrimination disorders. Conclusions Unusual motor and non-motor symptoms and signs in the early stage of PD can be difficult to interpret. Specialists should be aware of these conditions as clues to a potential diagnosis