Are Upper-Body Axial Symptoms a Feature of Early Parkinson’s Disease?
Identifieur interne : 000797 ( Pmc/Curation ); précédent : 000796; suivant : 000798Are Upper-Body Axial Symptoms a Feature of Early Parkinson’s Disease?
Auteurs : Caroline Moreau [France] ; David Devos [France] ; Guillaume Baille [France] ; Arnaud Delval [France] ; Céline Tard [France] ; Thierry Perez [France] ; Nicolas Danel-Buhl [France] ; David Seguy [France] ; Julien Labreuche [France] ; Alain Duhamel [France] ; Marie Delliaux [France] ; Kathy Dujardin [France] ; Luc Defebvre [France]Source :
- PLoS ONE [ 1932-6203 ] ; 2016.
Abstract
Axial disorders are considered to appear late in the course of Parkinson’s disease (PD). The associated impact on quality of life (QoL) and survival and the lack of an effective treatment mean that understanding and treating axial disorders is a key challenge. However, upper-body axial disorders (namely dysarthria, swallowing and breathing disorders) have never been prospectively assessed in early-stage PD patients.
To characterize upper-body axial symptoms and QoL in consecutive patients with early-stage PD.
We prospectively enrolled 66 consecutive patients with early-stage PD (less than 3 years of disease progression) and assessed dysarthria, dysphagia and respiratory function (relative to 36 controls) using both objective and patient-reported outcomes.
The mean disease duration was 1.26 years and the mean UPDRS motor score was 19.4 out of 108. 74% of the patients presented slight dysarthria (primarily dysprosodia). Men appeared to be more severely affected (i.e. dysphonia). This dysfunction was strongly correlated with low swallowing speed (despite the absence of complaints about dysphagia), respiratory insufficiency and poor QoL. Videofluorography showed that oral-phase swallowing disorders affected 60% of the 31 tested patients and that pharyngeal-phase disorders affected 21%. 24% of the patients reported occasional dyspnea, which was correlated with anxiety in women but not in men. Marked diaphragmatic dysfunction was suspected in 42% of the patients (predominantly in men).
Upper body axial symptoms were frequent in men with early-stage PD, whereas women presented worst non-motor impairments. New assessment methods are required because currently available tools do not reliably detect these upper-body axial disorders.
Url:
DOI: 10.1371/journal.pone.0162904
PubMed: 27654040
PubMed Central: 5031440
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<author><name sortKey="Delliaux, Marie" sort="Delliaux, Marie" uniqKey="Delliaux M" first="Marie" last="Delliaux">Marie Delliaux</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Are Upper-Body Axial Symptoms a Feature of Early Parkinson’s Disease?</title>
<author><name sortKey="Moreau, Caroline" sort="Moreau, Caroline" uniqKey="Moreau C" first="Caroline" last="Moreau">Caroline Moreau</name>
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</nlm:aff>
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<author><name sortKey="Devos, David" sort="Devos, David" uniqKey="Devos D" first="David" last="Devos">David Devos</name>
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<wicri:regionArea>Department of Neurology and Movement Disorders, CHU, Lille</wicri:regionArea>
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<author><name sortKey="Baille, Guillaume" sort="Baille, Guillaume" uniqKey="Baille G" first="Guillaume" last="Baille">Guillaume Baille</name>
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<author><name sortKey="Delval, Arnaud" sort="Delval, Arnaud" uniqKey="Delval A" first="Arnaud" last="Delval">Arnaud Delval</name>
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<author><name sortKey="Tard, Celine" sort="Tard, Celine" uniqKey="Tard C" first="Céline" last="Tard">Céline Tard</name>
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<author><name sortKey="Perez, Thierry" sort="Perez, Thierry" uniqKey="Perez T" first="Thierry" last="Perez">Thierry Perez</name>
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<author><name sortKey="Danel Buhl, Nicolas" sort="Danel Buhl, Nicolas" uniqKey="Danel Buhl N" first="Nicolas" last="Danel-Buhl">Nicolas Danel-Buhl</name>
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<author><name sortKey="Seguy, David" sort="Seguy, David" uniqKey="Seguy D" first="David" last="Seguy">David Seguy</name>
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<author><name sortKey="Labreuche, Julien" sort="Labreuche, Julien" uniqKey="Labreuche J" first="Julien" last="Labreuche">Julien Labreuche</name>
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<author><name sortKey="Duhamel, Alain" sort="Duhamel, Alain" uniqKey="Duhamel A" first="Alain" last="Duhamel">Alain Duhamel</name>
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</affiliation>
</author>
<author><name sortKey="Delliaux, Marie" sort="Delliaux, Marie" uniqKey="Delliaux M" first="Marie" last="Delliaux">Marie Delliaux</name>
<affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Neurology and Movement Disorders, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Neurology and Movement Disorders, CHU, Lille</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff007"><addr-line>INSERM UMR_S 1171, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>INSERM UMR_S 1171, Lille</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Dujardin, Kathy" sort="Dujardin, Kathy" uniqKey="Dujardin K" first="Kathy" last="Dujardin">Kathy Dujardin</name>
<affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Neurology and Movement Disorders, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Neurology and Movement Disorders, CHU, Lille</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff007"><addr-line>INSERM UMR_S 1171, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>INSERM UMR_S 1171, Lille</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
</affiliation>
</author>
<author><name sortKey="Defebvre, Luc" sort="Defebvre, Luc" uniqKey="Defebvre L" first="Luc" last="Defebvre">Luc Defebvre</name>
<affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Neurology and Movement Disorders, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Neurology and Movement Disorders, CHU, Lille</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff007"><addr-line>INSERM UMR_S 1171, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>INSERM UMR_S 1171, Lille</wicri:regionArea>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
</affiliation>
</author>
</analytic>
<series><title level="j">PLoS ONE</title>
<idno type="eISSN">1932-6203</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title>
<p>Axial disorders are considered to appear late in the course of Parkinson’s disease (PD). The associated impact on quality of life (QoL) and survival and the lack of an effective treatment mean that understanding and treating axial disorders is a key challenge. However, upper-body axial disorders (namely dysarthria, swallowing and breathing disorders) have never been prospectively assessed in early-stage PD patients.</p>
</sec>
<sec id="sec002"><title>Objectives</title>
<p>To characterize upper-body axial symptoms and QoL in consecutive patients with early-stage PD.</p>
</sec>
<sec id="sec003"><title>Methods</title>
<p>We prospectively enrolled 66 consecutive patients with early-stage PD (less than 3 years of disease progression) and assessed dysarthria, dysphagia and respiratory function (relative to 36 controls) using both objective and patient-reported outcomes.</p>
</sec>
<sec id="sec004"><title>Results</title>
<p>The mean disease duration was 1.26 years and the mean UPDRS motor score was 19.4 out of 108. 74% of the patients presented slight dysarthria (primarily dysprosodia). Men appeared to be more severely affected (i.e. dysphonia). This dysfunction was strongly correlated with low swallowing speed (despite the absence of complaints about dysphagia), respiratory insufficiency and poor QoL. Videofluorography showed that oral-phase swallowing disorders affected 60% of the 31 tested patients and that pharyngeal-phase disorders affected 21%. 24% of the patients reported occasional dyspnea, which was correlated with anxiety in women but not in men. Marked diaphragmatic dysfunction was suspected in 42% of the patients (predominantly in men).</p>
</sec>
<sec id="sec005"><title>Conclusion</title>
<p>Upper body axial symptoms were frequent in men with early-stage PD, whereas women presented worst non-motor impairments. New assessment methods are required because currently available tools do not reliably detect these upper-body axial disorders.</p>
</sec>
</div>
</front>
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<author><name sortKey="Salleron, J" uniqKey="Salleron J">J Salleron</name>
</author>
<author><name sortKey="Richard, F" uniqKey="Richard F">F Richard</name>
</author>
<author><name sortKey="Delbeuck, X" uniqKey="Delbeuck X">X Delbeuck</name>
</author>
<author><name sortKey="Derambure, P" uniqKey="Derambure P">P Derambure</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Berg, D" uniqKey="Berg D">D Berg</name>
</author>
<author><name sortKey="Postuma, R" uniqKey="Postuma R">R Postuma</name>
</author>
<author><name sortKey="Bloem, Br" uniqKey="Bloem B">BR Bloem</name>
</author>
<author><name sortKey="Chan, P" uniqKey="Chan P">P Chan</name>
</author>
<author><name sortKey="Dubois, B" uniqKey="Dubois B">B Dubois</name>
</author>
<author><name sortKey="Gasser, T" uniqKey="Gasser T">T Gasser</name>
</author>
</analytic>
</biblStruct>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id>
<journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id>
<journal-id journal-id-type="publisher-id">plos</journal-id>
<journal-id journal-id-type="pmc">plosone</journal-id>
<journal-title-group><journal-title>PLoS ONE</journal-title>
</journal-title-group>
<issn pub-type="epub">1932-6203</issn>
<publisher><publisher-name>Public Library of Science</publisher-name>
<publisher-loc>San Francisco, CA USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27654040</article-id>
<article-id pub-id-type="pmc">5031440</article-id>
<article-id pub-id-type="doi">10.1371/journal.pone.0162904</article-id>
<article-id pub-id-type="publisher-id">PONE-D-16-20530</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Neurology</subject>
<subj-group><subject>Neurodegenerative Diseases</subject>
<subj-group><subject>Movement Disorders</subject>
<subj-group><subject>Parkinson Disease</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject>
<subj-group><subject>Linguistics</subject>
<subj-group><subject>Speech</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Physiology</subject>
<subj-group><subject>Physiological Processes</subject>
<subj-group><subject>Ingestion</subject>
<subj-group><subject>Swallowing</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Physiology</subject>
<subj-group><subject>Physiological Processes</subject>
<subj-group><subject>Ingestion</subject>
<subj-group><subject>Swallowing</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Pulmonology</subject>
<subj-group><subject>Dyspnea</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Neuroscience</subject>
<subj-group><subject>Cognitive Science</subject>
<subj-group><subject>Cognitive Neuroscience</subject>
<subj-group><subject>Cognitive Neurology</subject>
<subj-group><subject>Neuropsychological Testing</subject>
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<subj-group><subject>Cognitive Neuroscience</subject>
<subj-group><subject>Cognitive Neurology</subject>
<subj-group><subject>Neuropsychological Testing</subject>
</subj-group>
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</subj-group>
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<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Neurology</subject>
<subj-group><subject>Cognitive Neurology</subject>
<subj-group><subject>Neuropsychological Testing</subject>
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</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Neuroscience</subject>
<subj-group><subject>Neuropsychology</subject>
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<subj-group><subject>Psychology</subject>
<subj-group><subject>Neuropsychology</subject>
<subj-group><subject>Neuropsychological Testing</subject>
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</subj-group>
</subj-group>
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<subj-group><subject>Psychology</subject>
<subj-group><subject>Neuropsychology</subject>
<subj-group><subject>Neuropsychological Testing</subject>
</subj-group>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Health Care</subject>
<subj-group><subject>Patients</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Physical Sciences</subject>
<subj-group><subject>Materials Science</subject>
<subj-group><subject>Materials by Structure</subject>
<subj-group><subject>Amorphous Solids</subject>
<subj-group><subject>Glass</subject>
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<subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject>
<subj-group><subject>Otorhinolaryngology</subject>
<subj-group><subject>Laryngology</subject>
<subj-group><subject>Dysphagia</subject>
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<title-group><article-title>Are Upper-Body Axial Symptoms a Feature of Early Parkinson’s Disease?</article-title>
<alt-title alt-title-type="running-head">Axial Signs in Early-Stage PD</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Moreau</surname>
<given-names>Caroline</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
<xref ref-type="corresp" rid="cor001">*</xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-2417-799X</contrib-id>
<name><surname>Devos</surname>
<given-names>David</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Baille</surname>
<given-names>Guillaume</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Delval</surname>
<given-names>Arnaud</given-names>
</name>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tard</surname>
<given-names>Céline</given-names>
</name>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Perez</surname>
<given-names>Thierry</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Danel-Buhl</surname>
<given-names>Nicolas</given-names>
</name>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Seguy</surname>
<given-names>David</given-names>
</name>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Labreuche</surname>
<given-names>Julien</given-names>
</name>
<xref ref-type="aff" rid="aff006"><sup>6</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Duhamel</surname>
<given-names>Alain</given-names>
</name>
<xref ref-type="aff" rid="aff006"><sup>6</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Delliaux</surname>
<given-names>Marie</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Dujardin</surname>
<given-names>Kathy</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Defebvre</surname>
<given-names>Luc</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff001"><label>1</label>
<addr-line>Department of Neurology and Movement Disorders, CHU, Lille, France</addr-line>
</aff>
<aff id="aff002"><label>2</label>
<addr-line>Department of Medical Pharmacology, Disorders, CHU, Lille, France</addr-line>
</aff>
<aff id="aff003"><label>3</label>
<addr-line>Department of Clinical Neurophysiology, Disorders, CHU, Lille, France</addr-line>
</aff>
<aff id="aff004"><label>4</label>
<addr-line>Department of Pulmonology, CHU, Lille, France</addr-line>
</aff>
<aff id="aff005"><label>5</label>
<addr-line>Department of Nutrition, Lille CHU, Lille, France</addr-line>
</aff>
<aff id="aff006"><label>6</label>
<addr-line>Department of Biostatistics, CHU, Lille, France</addr-line>
</aff>
<aff id="aff007"><label>7</label>
<addr-line>INSERM UMR_S 1171, Lille, France</addr-line>
</aff>
<aff id="aff008"><label>8</label>
<addr-line>University of Lille, Lille, France</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Maetzler</surname>
<given-names>Walter</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>University of Tuebingen, GERMANY</addr-line>
</aff>
<author-notes><fn fn-type="COI-statement" id="coi001"><p><bold>Competing Interests: </bold>
CM acts as a scientific advisor to Abbvie and Medtronic. DD acts as a scientific advisor to Apopharma, Aguettant, Abbvie, Teva, Lundbeck, Orkyn, GSK, Medtronic, Global Kinetics Corporation and Novartis. LD acts as a scientific advisor to Aguettant, Orkyn and Abbvie. DS acts as a scientific advisor to Abbvie. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.</p>
</fn>
<fn fn-type="con"><p><list list-type="simple"><list-item><p><bold>Conceptualization:</bold>
CM TP NDB DD.</p>
</list-item>
<list-item><p><bold>Data curation:</bold>
CM A. Delval.</p>
</list-item>
<list-item><p><bold>Formal analysis:</bold>
CM A. Delval DD CT GB MD.</p>
</list-item>
<list-item><p><bold>Funding acquisition:</bold>
CM.</p>
</list-item>
<list-item><p><bold>Investigation:</bold>
CM A. Delval.</p>
</list-item>
<list-item><p><bold>Methodology:</bold>
CM DD A. Duhamel JL LD.</p>
</list-item>
<list-item><p><bold>Project administration:</bold>
CM.</p>
</list-item>
<list-item><p><bold>Resources:</bold>
CM A. Delval DD LD KD.</p>
</list-item>
<list-item><p><bold>Software:</bold>
A. Duhamel A. Delval JL CT.</p>
</list-item>
<list-item><p><bold>Supervision:</bold>
CM DD LD.</p>
</list-item>
<list-item><p><bold>Validation:</bold>
A. Duhamel JL TP DS NDB.</p>
</list-item>
<list-item><p><bold>Visualization:</bold>
MD.</p>
</list-item>
<list-item><p><bold>Writing – original draft:</bold>
CM, DD.</p>
</list-item>
<list-item><p><bold>Writing – review & editing:</bold>
DD A. Duhamel A. Delval CT TP DS NDB KD DS LD.</p>
</list-item>
</list>
</p>
</fn>
<corresp id="cor001">* E-mail: <email>caroline.moreau@chru-lille.fr</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>21</day>
<month>9</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="collection"><year>2016</year>
</pub-date>
<volume>11</volume>
<issue>9</issue>
<elocation-id>e0162904</elocation-id>
<history><date date-type="received"><day>21</day>
<month>5</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>30</day>
<month>8</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>© 2016 Moreau et al</copyright-statement>
<copyright-year>2016</copyright-year>
<copyright-holder>Moreau et al</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>
, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p>
</license>
</permissions>
<self-uri content-type="pdf" xlink:href="pone.0162904.pdf"></self-uri>
<abstract><sec id="sec001"><title>Background</title>
<p>Axial disorders are considered to appear late in the course of Parkinson’s disease (PD). The associated impact on quality of life (QoL) and survival and the lack of an effective treatment mean that understanding and treating axial disorders is a key challenge. However, upper-body axial disorders (namely dysarthria, swallowing and breathing disorders) have never been prospectively assessed in early-stage PD patients.</p>
</sec>
<sec id="sec002"><title>Objectives</title>
<p>To characterize upper-body axial symptoms and QoL in consecutive patients with early-stage PD.</p>
</sec>
<sec id="sec003"><title>Methods</title>
<p>We prospectively enrolled 66 consecutive patients with early-stage PD (less than 3 years of disease progression) and assessed dysarthria, dysphagia and respiratory function (relative to 36 controls) using both objective and patient-reported outcomes.</p>
</sec>
<sec id="sec004"><title>Results</title>
<p>The mean disease duration was 1.26 years and the mean UPDRS motor score was 19.4 out of 108. 74% of the patients presented slight dysarthria (primarily dysprosodia). Men appeared to be more severely affected (i.e. dysphonia). This dysfunction was strongly correlated with low swallowing speed (despite the absence of complaints about dysphagia), respiratory insufficiency and poor QoL. Videofluorography showed that oral-phase swallowing disorders affected 60% of the 31 tested patients and that pharyngeal-phase disorders affected 21%. 24% of the patients reported occasional dyspnea, which was correlated with anxiety in women but not in men. Marked diaphragmatic dysfunction was suspected in 42% of the patients (predominantly in men).</p>
</sec>
<sec id="sec005"><title>Conclusion</title>
<p>Upper body axial symptoms were frequent in men with early-stage PD, whereas women presented worst non-motor impairments. New assessment methods are required because currently available tools do not reliably detect these upper-body axial disorders.</p>
</sec>
</abstract>
<funding-group><award-group id="award001"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/501100008211</institution-id>
<institution>Association France Parkinson</institution>
</institution-wrap>
</funding-source>
<principal-award-recipient><name><surname>Moreau</surname>
<given-names>Caroline</given-names>
</name>
</principal-award-recipient>
</award-group>
<funding-statement>The “Prodigy park I” study was funded by the France Parkinson charity in 2011 (€21,217). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement>
</funding-group>
<counts><fig-count count="0"></fig-count>
<table-count count="4"></table-count>
<page-count count="13"></page-count>
</counts>
<custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name>
<meta-value>All relevant data are within the paper and its Supporting Information files.</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
<notes><title>Data Availability</title>
<p>All relevant data are within the paper and its Supporting Information files.</p>
</notes>
</front>
</pmc>
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