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Nonmotor predictors for levodopa requirement in de novo patients with Parkinson's disease |
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| Authors: | Roberto Erro MD Marina Picillo MD Marianna Amboni MD PhD Marcello Moccia MD Carmine Vitale MD PhD Katia Longo MD PhD Maria Teresa Pellecchia MD PhD Gabriella Santangelo PhD Pablo Martinez-Martin MD PhD K. Ray Chaudhuri MD DSc Paolo Barone MD PhD |
| Affiliation: | 1. Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, United Kingdom Dipartimento di Scienze Neurologiche e del Movimento, Università di Verona, Policlinico Borgo Roma, Verona, Italy;2. University of Naples “Federico II”, Department of Neurological Science, Naples, Italy;3. IDC Hermitage–Capodimonte, Naples, Italy;4. IDC Hermitage–Capodimonte, Naples, Italy University of Naples “Parthenope”, Department of Motor Sciences, Naples, Italy;5. University of Salerno, Center for Neurodegenerative Diseases–CEMAND, Salerno, Italy;6. IDC Hermitage–Capodimonte, Naples, Italy Neuropsychology Laboratory, Department of Psychology, Second University of Naples, Caserta, Italy;7. Alzheimer Center Reina Sofia Foundation, Madrid, Spain CIBERNED, Carlos III Institute of Health, Madrid, Spain;8. National Parkinson Foundation International Center of Excellence, Kings College Hospital, Kings College, London, United Kingdom |
| Abstract: | The variability in the clinical phenotype of Parkinson's disease (PD) suggests the existence of several subtypes of the disease. Motor heterogeneity of PD is well established, but not nonmotor heterogeneity. At present, we are unable to predict the rate of progression of PD based on robust biomarkers. We aimed to examine the heterogeneity of PD by attempting to identify nonmotor factors associated with the rate of motor progression and functional decline, as measured by the time to reach the need for levodopa therapy during the first 4 years from diagnosis in a cohort of de novo PD patients. The median time to introduction of l -dopa for patients with urinary symptoms was significantly shorter than that for those without (20 vs. 37 months; P = 0.001). Cox's regression models showed that the urinary domain was associated with a higher probability of starting l -dopa (hazard ratio: 2.1; P = 0.002). There was no influence of such confounders as sex, age, baseline motor features, use of dopamine agonists and/or monoamine oxidase B inhibitors, and total l -dopa equivalent daily dosage. Patients with urinary symptoms had higher baseline and follow-up motor and nonmotor disturbances than those without. Our study suggests the existence of a subgroup of patients who show urinary symptoms along with an overall higher motor and nonmotor burden. Such patients are prone to manifest a rapid functional decline over the first 4 years of the disease. Urinary symptoms might be a clinical marker of severity as well as a possible nonmotor subtype of PD. © 2015 International Parkinson and Movement Disorder Society |
| Keywords: | nonmotor symptoms early Parkinson's disease de novo newly diagnosed progression PD subtypes |