Population-based Studies on the Clinical Progression of Motor and Non-motor Features in Parkinson’s Disease

Population-based Studies on the Clinical Progression of Motor and Non-motor Features in Parkinson’s Disease

Alves Guido, Larsen Jan Petter

European Neurological Review, 2009;4(1):36-9

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Abstract
Although Parkinson’s disease (PD) is a movement disorder in which tremor, rigidity and bradykinesia constitute the cardinal signs of the disease, it is increasingly recognised to be associated with a wide range of motor and non-motor features. Population-based studies demonstrate that the motor course in PD is generally slowly progressive, with average annual progression rates of ≤3%. However, there is remarkable inter-individual variation in the clinical course of PD, with advanced age and predominant postural instability and gait difficulties being major risk factors for more rapid motor and cognitive decline. Around 20–40% of patients exhibit subtle cognitive deficits at diagnosis. These usually worsen over time and progress into dementia, which approximately 80% of PD subjects develop during the course of their disease. Population-based studies indicate rather high frequencies of other non-motor symptoms in moderate to advanced stages, such as depression, fatigue, apathy, sleep disordes and autonomic dysfunction, although prevalence rates often are lower than those observed in clinic-based studies. However, as several population-based studies were cross-sectional, uncontrolled and did not use currently accepted rating scales or diagnostic criteria, the relative risk and clinical course of many disease-related features remain unclear in the general PD population. Further population-based studies are warranted in order to extend current knowledge on the clinical course in representative PD cohorts.

Keywords Parkinson’s disease (PD), progression, course, decline, population-based, community-based, epidemiology
Disclosure: The authors have no conflicts of interest to declare.
Received: 17 February 2009 Accepted: 17 August 2009
Correspondence: Guido Alves, Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway. E: algu@sus.no

Parkinson’s disease (PD) is the most common neurodegenerative movement disorder, affecting more than one million people in Europe. The cardinal features of the disease include resting tremor, bradykinesia, rigidity and postural abnormalities. Long understood as a solely movement disorder caused by progressive neuronal cell loss and dopamine depletion in the nigrostriatal system, PD is today recognised as a multisystem brain disorder that causes a wide range of motor and non-motor symptoms. Given that the first description of PD was published almost 200 years ago1 and the disease is recognised to be frequent, disabling and costly,2 one might presume that its clinical characteristics and course are well described. However, although numerous epidemiological studies have been conducted during recent decades to assess the phenomenology and pattern of PD, the number of studies providing longitudinal data on its clinical course is rather limited.

Even fewer studies have been performed to prospectively asses he progression of motor or non-motor features in population-based cohorts, despite the fact that such information is probably best suited to give a correct description on how the disease progresses in the general PD population. Such information is important for patients, care-givers and healthcare planning. In this article we provide an overview of current knowledge of the clinical course of motor and non-motor features of PD derived from population-based studies.



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Keywords:
Parkinson’s disease (PD), progression, course, decline, population-based, community-based, epidemiology, diagnosis Parkinson’s disease, Parkinson’s disease tremor, Parkinson’s disease levodopa, Parkinson’s disease deep brain stimulation, Parkinson’s disease dopamine agonists, bradykinesia Parkinson’s disease,

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