To investigate the duration of a prodromal phase before the onset of the classic symptoms of idiopathic Parkinson's disease, the authors conducted a retrospective case-control study of 60 patients with Parkinson's disease and 58 age- and sex-matched control subjects, covering the decade preceding the onset of classic Parkinson's disease. The symptoms were derived from files of the patients' general practitioners. Compared with control subjects, patients pre-Parkinson's disease had more central nervous system, psychologic, musculoskeletal, and cardiovascular (i.e., autonomic) symptoms. Patients pre-Parkinson's disease also made more visits to general practitioners and medical specialists. The results indicate that the onset of classic parkinsonism is frequently preceded by a prodromal phase lasting from 4-6 years.
SUMMARY Eighteen patients suffering from Parkinson's disease and nineteen control subjects, who were matched for age and intelligence, were compared in tests measuring "shifting aptitude" at cognitive and motor levels (word production, sorting blocks or animals, and finger pushing sequences). It was found that Parkinson patients produced fewer different names of animals and professions in one minute than control subjects, needed more trials for detecting a shift in a sorting criterion, and produced fewer finger responses in a change of pushing sequence than control subjects. These results are interpreted as reflecting a central programming deficit that manifests itself in verbal, figural and motor modalities, that is, a diminished "shifting aptitude" characteristic of patients with dysfunctioning basal ganglia. The results are discussed in relation to changes of behaviour organisations in animals with dysfunctioning basal ganglia.For many years, the basal ganglia have been known to be involved in motor functioning. The basal ganglia are also believed to play a circumscribed role in programming ongoing behaviour.'-' There is, also, belief that the basal ganglia play a definite role in cognitive functioning.8-'3 (cf. refs 14-i5.) Of
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