Non-motor symptoms in a prevalent population with Parkinson's disease in Tanzania

Abstract

Introduction: Most of the patients identified in a community-based prevalence study of Parkinson's disease (PD) in the Hai district, rural northern Tanzania, in 2005-2006, had not been previously diagnosed or treated.

Methods: Screening methods to identify patients have been previously described. Diagnosis was confirmed by the UK, PD Society Brain Bank Criteria. Patients were assessed in their own home with the assistance of a local translator and completed: Unified PD Rating Scale (UPDRS), Non-motor Symptoms Assessment Scale, PDQ-39, Hoehn and Yahr scale, and Hospital Anxiety and Depression Scale (HAD).

Results: Thirty-three (23 male, mean age 74, range 38-94 years) patients were identified. Only 5 had ever taken PD medication, and only 3 were currently treated. Hoehn and Yahr stage ranged from 2 to 5, disease duration from 3 months to 19 years, mean UPDRS was 50 (range 24-97), mean PDQ-39 386 (range 219-580) and mean non-motor symptom scale score 62 (range 11-209). Some patients who had never taken medication for PD, and who did not fulfil the Lewy Body Dementia diagnostic criteria, had experienced visual hallucinations.

Conclusions: By studying patients at varying stages of PD who have not received treatment we can learn more about the symptoms of late stage PD and ascertain whether they are drug- or disease-related, or a combination of both. Hallucinations are likely to be a manifestation of the disease, but are often precipitated or exacerbated by medication. These patients have now commenced treatment, with close monitoring for complications, including motor or neuro-psychiatric symptoms.