Abstract
A large body of evidence indicates that the progression of Parkinson's disease (PD) may be fast in the preclinical stage as well as during the first years of the disease, with a subsequent slowing down of the disease process. As has been shown in the Deprenyl and Tocopherol Antioxidative Therapy of Parkinsonism (DATATOP) study, the Unified Parkinson's Disease Rating Scale (UPDRS) motor examination scores declined at a rate of 8 to 9% per year in untreated patients. A subgroup of levodopa-naive DATATOP patients ("survivors") showed a much slower rate of progression, in the order of 3% per year, suggesting a more benign disease course. A number of clinical factors that may govern the rate of motor decline, such as age at onset, disease duration, gender, and clinical phenotype (akinetic-rigid versus tremulous) have been proposed; however, none of them is proven. In contrast, dopaminergic substitution undoubtedly has had a major impact on the natural history of PD, resulting in a reduction of the mortality ratio from about 3.0 to 1.5. This benefit has been noted particularly in patients in whom levodopa therapy was started early. The positive impact of levodopa is largely derived from its symptomatic action; its influence on the di...Continue Reading
Citations
Sep 5, 1998·Clinical Pharmacology and Therapeutics·S Harder, H Baas
Jul 21, 1998·Annals of the New York Academy of Sciences·J S Schneider
May 2, 2002·Acta Neurologica Scandinavica·J Finsterer
Mar 29, 2011·Journal of Neurology·Catherine DotchinRichard Walker
May 5, 2012·Movement Disorders : Official Journal of the Movement Disorder Society·Katrina L PaumierUNKNOWN Parkinson Study Group Genetics Epidemiology Working Group
Jan 12, 2001·Acta Neurologica Scandinavica·M K BeyerJ P Larsen
Apr 6, 2016·Neurology·Rohit Dhall, David L Kreitzman
May 24, 2016·Translational Neurodegeneration·Wissam DeebAparna Wagle Shukla
Nov 11, 1999·Pharmacotherapy·M D Gottwald
Jun 20, 2003·Movement Disorders : Official Journal of the Movement Disorder Society·UNKNOWN Movement Disorder Society Task Force on Rating Scales for Parkinson's Disease
Nov 26, 2003·Movement Disorders : Official Journal of the Movement Disorder Society·Walter PirkerThomas Brücke
Sep 17, 2004·Movement Disorders : Official Journal of the Movement Disorder Society·Christopher G GoetzUNKNOWN Movement Disorder Society Task Force on Rating Scales for Parkinson's Disease
Apr 30, 2008·Movement Disorders : Official Journal of the Movement Disorder Society·Martin KöllenspergerUNKNOWN European MSA Study Group
Mar 11, 2017·Movement Disorders Clinical Practice·Matej SkorvanekGlenn T Stebbins
Jun 5, 1998·Movement Disorders : Official Journal of the Movement Disorder Society·G K WenningW Poewe
Apr 28, 2004·Neurotoxicity Research·Diego BustamanteMario Herrera-Marschitz
Mar 23, 2002·Annual Review of Public Health·Philip D SloaneS Sudha
Aug 18, 2004·Journal of Geriatric Psychiatry and Neurology·Dag AarslandGlenda Halliday
Apr 7, 2007·Movement Disorders : Official Journal of the Movement Disorder Society·Anette SchragNiall P Quinn
Aug 7, 2019·Neurology·David BäckströmLars Forsgren
Aug 2, 2001·Movement Disorders : Official Journal of the Movement Disorder Society·E NurmiJ O Rinne
Feb 20, 2021·PloS One·Tiwana VarrecchiaMariano Serrao
Aug 6, 2010·Brain Research Reviews·Anthony C VernonMichel Modo
Sep 7, 2021·Frontiers in Neurology·Sabrina PoonjaFang Ba