Introduction A range of non-motor features can be evident at the point of diagnosis of Parkinson’s disease (PD).

Objectives To identify non-motor features of prodromal PD in participants from the PREDICT-PD study.

Methods Higher-risk (HR) (odds of PD >1:30) and matched lower-risk (LR) participants from PREDICT-PD and PD patients underwent validated clinical assessments, in which the assessor was blinded to risk scores, including MDS-UPDRS I-III, other functional motor tasks, and standardised assessments of cognition, autonomic function, pain and sleep.

Results 28 LR, 31 HR and 22 PD patients were examined. HR participants were more impaired than LR in all motor tasks, as well as the SCOPA-AUT, PD Sleep scale, HADS and MDS-UPDRS I & II. There were no sig- nificant differences between HR and PD, other than for the MDS-UPDRS part II, part III, the gastrointestinal sub-score of the SCOPA-AUT, and measured orthostatic hypotension. In all domains tested there was a relationship between the log odds of PD risk and dysfunction using linear regression.

Conclusion This study provides strong evidence that non-motor features are prominent in at-risk indi- viduals, as well as mild motor impairment, and that these symptoms and signs are similar to patients with established PD. Further follow-up will establish which patients develop the cardinal motor signs necessary for a clinical diagnosis of PD.