BACKGROUND: Recognition of motor signs in the prodromal stage could lead to best identify populations at risk for developing Parkinson's disease (PD). OBJECTIVE: This study identified motor symptoms and signs in individuals suspected of having PD but who did not have a progressive reduction in the speed and amplitude of finger tapping or other physical signs indicative of bradykinesia. METHODS: 146 patients, who had symptoms or signs suggestive of PD, were serially evaluated by a movement disorder specialist, using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III and video recordings. If the patients 'converted' to PD during follow-up, they were categorized as cases and compared with those who did not meet PD criteria during follow-up (non-cases). RESULTS: The 82 cases were more likely to have action dystonia or postural/action/rest tremor of a limb (OR 2.8; 95% CI 1.10-7.09; p = 0.02), a reduced blink rate at rest (OR 2.32; 95% CI 1.18-4.55; p = 0.01), anxiety (OR 8.91; 95% CI 2.55-31.1; p < 0.001), depression (OR 7.03; 95% CI 2.86-17.2; p < 0.001), or a frozen shoulder (OR 3.14; 95% CI 1.58-6.21) than the 64 'non-cases'. A reduction of the fast blink rate was common in patients who met the criteria for PD (p < 0.001). CONCLUSIONS: This study emphasizes that motor dysfunction is a component of the clinical prodrome seen in some patients with PD
