Prodromal Diagnoses in the Electronic Medical Record (EMR) Differ in Parkinson’s Disease (PD), Dementia with Lewy Bodies (DLB), Multiple System Atrophy (MSA), and Progressive Supranuclear Palsy (PSP) (P3.347)

Objective: To identify prodromal patterns of diagnoses in PD, DLB, MSA and PSP using the EMR. Background: Prodromal features [e.g., hyposmia, constipation, rapid eye movement sleep behavior disorder (RBD)] precede PD by years (Ross, 2011), and may be identified in the EMR before PD diagnosis (Savica 2009, Schrag 2015). Whether prodromal diagnoses in the EMR precede the onset of parkinsonism other than PD has not been investigated. Methods: Newly diagnosed neurologist confirmed cases with parkinsonism due to PD, DLB, MSA or PSP and controls matched by age, gender and duration of membership were identified from Northern California Kaiser Permanente between 2004-2010. The association of selected prodromal diagnoses with each parkinsonian syndrome was determined using odds ratios (OR) adjusted for age, gender, duration of membership and smoking behavior. Results: 2717 PD/13585 controls, 291 DLB/1455 controls, 80 MSA/890 controls and 84 PSP/840 were studied. Future diagnosis of PD was associated with prior diagnoses of RBD (OR 3, 95[percnt] CI 1.8,5.1), constipation (OR 2.8, 95[percnt] CI 2.5,3.1), hyposmia (OR 1.9, 95[percnt] CI 1.2,3.0), neurogenic bladder (OR 1.6, 95[percnt] CI 1.2,2.3) or seborrheic dermatitis (OR 1.6, 95[percnt] CI 1.3,2.0). Future diagnosis of DLB was associated with prior diagnosis of RBD (OR 21.2, 95[percnt] CI 5.8,77.3) or constipation (OR 2.6, 95[percnt] CI 1.8,3.6). Future diagnosis of MSA was associated with prior diagnosis of neurogenic bladder (OR 21.9, 95[percnt] CI 2.5,192.4) or constipation (OR 6.0, 95[percnt] CI 2.0,8.2). Future diagnosis of PSP was associated with prior diagnosis of neurogenic bladder (OR 9.9, 95[percnt] CI 1.5, 65.8). Conclusions: Antecedent diagnoses predicting PD were confirmed. Different patterns of antecedent diagnoses were associated with future DLB, MSA or PSP. Caveat: clinical distinction of parkinsonian syndromes in early disease may be inaccurate. Electronic record surveillance may help to predict those at risk for PD, DLB, MSA or PSP. Disclosure: Dr. LaHue has nothing to disclose. Dr. Albers has nothing to disclose. Dr. Goldman has nothing to disclose. Dr. Leimpeter has nothing to disclose. Dr. Van Den Eeden has nothing to disclose. Dr. Tanner has received personal compensation for activities with Neurocrine and Ultragenyx Pharmaceuticals as a consultant.