@article{ref1,
title="Severity of daytime sleepiness and Parkinsonian-like symptoms in Korean adults aged 50-64 years",
journal="Journal of clinical neurology",
year="2022",
author="Shin, Chol and Kim, Regina E. Y. and Thomas, Robert J. and Yun, Chang-Ho and Lee, Seung Ku and Abbott, Robert D.",
volume="18",
number="1",
pages="33-40",
abstract="BACKGROUND AND PURPOSE: While excessive daytime sleepiness can predate Parkinson's disease in late-life, its association with parkinsonian-like (P-L) symptoms in middle age are unknown. Since neurodegeneration can appear decades before a diagnosis of Parkinson's disease, identifying clinical features associated with this early progression is important. The purpose of this study was to determine the association of daytime sleepiness with P-L symptoms in a population-based sample of middle-aged Korean adults. <br><br>METHODS: During 2013 and 2014, daytime sleepiness and P-L symptoms were assessed in 2,063 males and females aged 50-64 years who were participating in the Korean Genome and Epidemiology Study. The severity of daytime sleepiness was quantified by the score on the Epworth Sleepiness Scale (ESS). Self-reported P-L symptoms included nine motor disorders commonly associated with Parkinson's disease. Participants with parkinsonism and related conditions are excluded. <br><br>RESULTS: The prevalence of excessive daytime sleepiness (ESS score >10) was 7.0%. The frequencies of P-L symptoms ranged from 0.5% (for &quot;trouble buttoning buttons&quot;) to 18.4% (for &quot;handwriting smaller than it once was&quot;). After adjustment for covariates and multiple testing, the relative odds of P-L symptoms comparing the 80th and 20th percentiles of ESS scores was 1.6 (p=0.001) for &quot;voice is softer than it once was,&quot; 2.1 (p<0.001) for &quot;balance when walking is poor,&quot; and 1.5 (p=0.002) for &quot;loss of facial expression.&quot; The prevalence of excessive daytime sleepiness increased from 6.3% to 19.8% when the number of symptoms increased from zero to three (p=0.004). <br><br>CONCLUSIONS: In Korean adults aged 50-64 years, daytime sleepiness is significantly associated with P-L symptoms. Whether coexisting daytime sleepiness and P-L symptoms predate extrapyramidal and other impairments in later life warrants further investigation.<p /> <p>Language: en</p>",
language="en",
issn="1738-6586",
doi="10.3988/jcn.2022.18.1.33",
url="http://dx.doi.org/10.3988/jcn.2022.18.1.33"
}