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Handedness and motor symptom asymmetry in Parkinson's disease
  1. Matthew J Barrett1,
  2. Scott A Wylie2,
  3. Madaline B Harrison2,
  4. G Frederick Wooten2
  1. 1Department of Neurology, Beth Israel Medical Center, New York, USA
  2. 2Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
  1. Correspondence to Dr Matthew J Barrett, Beth Israel Medical Center, Department of Neurology, 10 Union Square East, Suite 5K, New York, NY 10003, USA; mabarrett{at}


Background The objective of this study was to confirm whether an association between handedness and the side of symptom onset exists and to evaluate the impact of this association on specific clinical characteristics of Parkinson's disease (PD).

Methods 1173 PD patients were identified from a clinical database. Patients with asymmetrical onset (n=1015) were divided into those with dominant-side onset and those with non-dominant-side onset, and the clinical characteristics of the two subgroups were compared.

Results In our PD sample, 86.5% of patients presented asymmetrically. There was a significant association between handedness and the side of the initial symptom; that is, the dominant side was affected first in the majority of both left- and right-handed patients. Compared with patients with non-dominant side onset, more patients with dominant-side onset presented with bradykinesia, while fewer patients presented with gait difficulty. Patients with dominant-side onset were diagnosed and began dopaminergic medication after a longer symptom duration than patients with non-dominant-side onset. The only difference in Unified Parkinson Disease Rating Scale scores between the two groups was in a subscore addressing dominant-hand tasks.

Conclusions An association exists between the dominant hand and the side of the initial motor symptom in PD. Whether the initial symptom occurs on the dominant or non-dominant side has implications for the reported first symptom, the time to diagnosis and the time to dopaminergic treatment initiation. The side of disease onset does not affect the severity of disease, as measured by the Unified Parkinson Disease Rating Scale.

  • Parkinson disease
  • functional laterality
  • natural history
  • basal ganglia

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  • Funding This study was funded by Morris K Udall Center at the University of Virginia, Grant Number: NIH-NINDS-P50-NS39788; American Parkinson Disease Association Advanced Center; and Parkinson Disease Research at UVA.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the University of Virginia IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.