Abstract
To date, no consensus exists on the key factors for diagnosing advanced Parkinson disease (APD). To obtain consensus on the definition of APD, we performed a prospective, multicenter, Spanish nationwide, 3-round Delphi study (CEPA study). An ad hoc questionnaire was designed with 33 questions concerning the relevance of several clinical features for APD diagnosis. In the first-round, 240 neurologists of the Spanish Movement Disorders Group participated in the study. The results obtained were incorporated into the questionnaire and both, results and questionnaire, were sent out to and fulfilled by 26 experts in Movement Disorders. Review of results from the second-round led to a classification of symptoms as indicative of “definitive,” “probable,” and “possible” APD. This classification was confirmed by 149 previous participating neurologists in a third-round, where 92% completely or very much agreed with the classification. Definitive symptoms of APD included disability requiring help for the activities of daily living, presence of motor fluctuations with limitations to perform basic activities of daily living without help, severe dysphagia, recurrent falls, and dementia. These results will help neurologists to identify some key factors in APD diagnosis, thus allowing users to categorize the patients for a homogeneous recognition of this condition.
Highlights
Parkinson disease (PD) is the second most common agerelated neurodegenerative disorder after Alzheimer’s disease, affecting nearly 1% of the population over 60 years and 5% in subjects up to 85 years [1, 2], with high health, social, and economic impact [3].While currently effective antiparkinsonian drugs are available, allowing patients to have an acceptable functional capacity during the early years of PD, as time goes by, motor and functional deterioration develop, partly due to the presence of motor and nonmotor complications, highly influencing patients’ quality of life
Current evidence suggests that both motor and nonmotor symptoms significantly contribute to health status and quality of life in PD [8]
Such limitation results from a combination of motor impairment and complications, and from nonmotor symptoms that can restrict the activity through a diversity of ways and aging [16, 17]
Summary
While currently effective antiparkinsonian drugs are available, allowing patients to have an acceptable functional capacity during the early years of PD, as time goes by, motor and functional deterioration develop, partly due to the presence of motor and nonmotor complications, highly influencing patients’ quality of life. At this stage, the conventional medication is unable to provide an adequate clinical control [4,5,6] and the term advanced PD is frequently used (APD). It is of interest to know the patients’ clinical characteristics that can define APD and that make these patients eligible for advanced therapies
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