The natural history of Parkinson’s disease

  title={The natural history of Parkinson’s disease},
  author={Werner Poewe},
  journal={Journal of Neurology},
  • W. Poewe
  • Published 1 December 1996
  • Medicine, Psychology
  • Journal of Neurology
Although Parkinson’s disease (PD) is the only chronic neurodegenerative disorder for which there are effective symptomatic therapies no treatment has yet been identified that would significantly slow its natural progression. Studies into the natural history of Parkinson’s disease have been complicated by issues of diagnostic accuracy, heterogeneity of different forms of the disease as well as confounding effects of age related comorbidities.Only recently results from placebo-controlled clinical… 

The factor structure of the UPDRS as an index of disease progression in Parkinson's disease.

Invest exploratory factor analysis (EFA) indicates that the UPDRS captures meaningful aspects of disease progression in PD, and that it is possible to identify symptom/sign complexes which evolve independently of one another.

Early Parkinson’s Disease. Incidence, clinical features and quality of life in a population-based cohort study.

All cases of incident PD from the Norwegian counties Sogn og Fjordane, Hordaland, Rogaland and Aust-Agder, comprising a base-population of about 1 million inhabitants were recruited and cases with probable PD were invited to further examinations and longitudinal follow-up.

Parkinson ’ s Disease and Quality of Life – A Clinician ’ s Perspective

The differences in effect on non-motor symptoms of different CDS treatments may indicate a future where treatment can be directed at improving specific non-Motor symptoms and thus the QoL of people with PD.

Assessment of disease progression and functional benefit in neurodegenerative disease: Can we tell the difference?

This review summarizes recent trials in ALS and Parkinson's disease, with the goal of increasing understanding of how the choice of outcome measures influences what can be concluded from the results.

The Importance of Rehabilitation Treatment in Patients with Parkinson’s Disease

More systematic reviews and meta-analysis support the hypothesis on the positive effects of physiotherapy and intensive kinesiotherapy in PD patients, and all modalities for improving the gait function are essentially a lifelong activity.

Levodopa for the treatment of Parkinson’s disease: current perspectives

At present there is no clear evidence from basic and clinical studies that levodopa has an adverse effect on the progression of Parkinson’s disease, and the nonphysiological pulsatile stimulation of striatal dopamine receptors induced by periodic dosing of orallevodopa formulations may play a key role in the pathogenesis of motor fluctuations and dyskinesias.

The Trajectory of Motor Deterioration to Death in Parkinson's Disease

Examination of Unified Parkinson's Disease Rating Scale motor score trajectories at the end of life in PD identified dominant types of motor trajectory in PD that can help clinicians understand their patients' course of illness.

Statistical Models of Parkinson's Disease Progression: Predictive Validity in a 3-Year Follow-up.

A cross-sectional assessment of a PD population allowed the development of regression-based models of disease progression, whose predictive value was validated on a three-year longitudinal study.


Treatment and investigational approaches to PD have been markedly expanded in the past several years and include treatments and treatment strategies aimed at restoring function to PD patients in the advanced stages of the illness, preventing the development of the motor complications that are the major source of disability for a large percentage of PD patients, and modifying the disease process so as to slow or halt disease progression.



Clinical observations on the rate of progression of idiopathic parkinsonism.

It is concluded that age and duration of symptoms influence the natural history of IP additively and independently and the rate of neuronal death is more rapid in the earlier stages of evolution of the pathology; subsequently, the velocity of progression slows down to approach the rates of attrition produced by normal ageing.

Long-term responses of Parkinson's disease to levodopa therapy.

It appears that levodopa has only a limited period of usefulness in the treatment of Parkinson's disease as it does not arrest the pathological progress and modify the natural course of the disease.

Severity of Parkinson's disease is a risk factor for peak-dose dyskinesia.

The severity of Parkinson's disease is the main risk factor for peak-dose dyskinesia, and the duration of levodopa therapy is not a factor.

Levodopa therapy and survival in idiopathic Parkinson's disease

We studied survival in all Olmsted County Parkinson's disease (PD) patients seen at the Mayo Clinic from 1964 to 1978, attempting to answer two questions: (1) What effect does levodopa have on

Parkinsonism treated with levodopa: progression and mortality.

  • M. M. Maier Hoehn
  • Medicine, Psychology
    Journal of neural transmission. Supplementum
  • 1983
Patients with Parkinson's disease treated with levodopa over the past 15 years were compared, by parallel statistical methods, to a group of similar patients followed for 15 years before thelevodopa era, to find no real evidence that delaying therapy confers benefits in the future.

Young onset Parkinson's disease

It is believed that most, if not all, patients in this group have degenerative Lewy body idiopathic Parkinson's disease, representing the lower end of a skewed deviation for age of onset of this disease.

Five years' treatment of Parkinson's disease with levodopa. Therapeutic results and survival of 100 patients.

Despite its inability to cure Parkinson's disease, levodopa provides symptomatic relief for a prolonged time and it remains the single most effective medication for the illness.

DATATOP: a multicenter controlled clinical trial in early Parkinson's disease. Parkinson Study Group.

  • Medicine, Psychology
    Archives of neurology
  • 1989
A large DATATOP cohort is expected to provide a high likelihood (power) for detecting significant treatment effects, if indeed they exist, and no selection biases were identified that might confound the primary end-point analysis.

Effect of age at onset on progression and mortality in Parkinson's disease

Results from the disability analyses indicate that patients with onset of Parkinson's disease under 50 years of age may have a more favorable prognosis than those whose symptoms begin in later years.

Does ageing aggravate parkinsonian disability?

It is suggested that age of onset mainly affects the response to levodopa therapy, because it may increase the prevalence of non-dopaminergic lesions of the brain, including those responsible for gait disorders.