Evaluation of non-motor symptoms in Parkinson's disease for potential application to early diagnosis

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We investigated the non-motor symptoms of Parkinson's disease and explored their availability for early diagnosis. Rapid eye movement (REM) sleep behavior disorder (RBD) can be an early symptom of alpha-synucleinopathies including Parkinson's disease. We examined whether the cognitive and autonomic symptoms reported in these conditions also developed in RBD patients. We also examined whether the patients had preclinical nerve degeneration in the nigrostriatal dopaminergic system using dopamine transporter PET. The results were as follows. (1) The dopamine transporter PET indicated the reduced pre-synaptic function in the nigrostriatal dopaminergic system in 2 out of 3 RBD patients. (2) Olfactory recognition and social-cognition including facial-expression recognition and decision-making was impaired in two patients with the reduced pre-synaptic function. (3) Autonomic signs such as decreased myocardial 123I-metaiodobenzylguanidine (MIBG) uptake and constipation were present in all patients. The social-cognitive and autonomic symptoms in the RBD patients were consistent with those of PD patients. Based on the consistence and the reduced pre-synaptic function in the nigrostriatal system, we predicted that motor symptoms may develop in those RBD patients in the near future.