The natural history of parkinson's disease

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Abstract
There are still insufficient data on the natural course of Parkinson's disease (PD) owing to lack of standardized longitudinal follow‐up studies. Reported progression rates in early PD vary considerably by a factor of 2 to 3. Similarly, data from sequential [18F]dopa PET studies in PD patients have produced variable decline rates of PET indices ranging between 7 and 70% per decade. Risk factors for rapid progression include old age at onset, concomitant major depression, dementia, and akinetic‐rigid symptom presentation. The introduction of levodopa into the routine treatment of PD patients had a dramatic impact on symptomatic control without affecting the underlying rate of disease progression. By contrast, monoamine oxidase (MAO) B inhibition by deprenyl monotherapy in early PD was shown to delay the need for levodopa by around 9 months. However, the neuroprotective action disappeared after 2 years of follow‐up. Furthermore, deprenyl also failed to influence the subsequent development of levodopa‐induced motor complications. Available studies on mortality in PD provide heterogeneous mortality rates, probably because of discrepancies between patient populations with respect to co‐morbidity, disease stage at study entry, and diagnostic accuracy. However, the most recent follow‐up from the DATATOP cohort suggests normal life expectancy in carefully selected patients without significant co‐morbidity and with adequate treatment and expert follow‐up.

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