Progression of motor and nonmotor features of Parkinson's disease and their response to treatment
Identifieur interne : 000223 ( Pmc/Corpus ); précédent : 000222; suivant : 000224Progression of motor and nonmotor features of Parkinson's disease and their response to treatment
Auteurs : Thuy Vu ; John Nutt ; Nicholas HolfordSource :
- British Journal of Clinical Pharmacology [ 0306-5251 ] ; 2012.
Abstract
(i) To describe the progression of the cardinal features of Parkinson's disease (PD); (ii) to investigate whether baseline PD subtypes explain disease progression; and (iii) to quantify the symptomatic and disease-modifying effects of anti-parkinsonian treatments.
Data were available for 795 PD subjects, initially untreated, followed for up to 8 years. Cardinal features [tremor, rigidity, bradykinesia, and postural instability and gait disorder (PIGD)] were derived from the total unified Parkinson's disease rating scale (total UPDRS), cognitive status from the mini-mental status exam score (MMSE) and depression status from the Hamilton depression scale (HAM-D). Analysis was performed using a nonlinear mixed effects approach with an asymptotic model for natural disease progression. Treatment effects (i.e. symptomatic and disease modifying) were evaluated by describing changes in the natural history model parameters.
Tremor progressed more slowly (half-time of 3.9 years) than all other motor features (half-time 2–3 years). The MMSE progression was negligible, while HAM-D progressed with a half-time of 5 years. Levodopa had marked symptomatic effects on all features, but low potency for effect on PIGD (
This analysis indicates that tremor progresses more slowly than other cardinal features and that PIGD is less treatment responsive in early PD patients. There was no evidence of baseline PD subtypes as a clinically useful predictor of disease progression rate. Anti-parkinsonian treatments have symptomatic and disease-modifying effects on all major features of PD.
Url:
DOI: 10.1111/j.1365-2125.2012.04192.x
PubMed: 22283961
PubMed Central: 3630747
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