Rate of Progression of Parkinson’s Disease in Early and Late Prescription of Levodopa

Abstract

Objectives. To optimize levodopa treatment depending on the rate of disease progression. Materials and methods. A total of 86 patients with Parkinson’s disease were studied. The rate of progression was evaluated in terms of the time taken to reach stage 3. Assessment of patients’ status was based on the MDS-UPDRS, MMSE, Beck Depression Scale, scales for apathy and autonomic impairments, tests for verbal activity, and the clock drawing test. Results and conclusions. Earlier initiation of levodopa treatment in 37 patients (mean 1.7 years from onset of PD) led to the appearance of signs of reaching disease stage 3 later than those given levodopa later (mean 7.3 ± 4.4 years vs. 5.8 ± 2.8 years). The development of dyskinesias occurred at the same times in patients with early initiation of levodopa as in those with later initiation (7.5 years vs. 7.9 years from onset of PD). Retention of asymmetry in clinical manifestations during the course of disease, REM sleep behavior disorder, and orthostatic hypotension were predictors of a high risk of complications of levodopa. More severe axial impairments predicted faster progression, low levodopa efficacy, and a lower risk of dyskinesia. Thus, delayed initiation of levodopa was linked with faster progression, while the development of therapeutic dyskinesia depended more on the duration of disease than the time at which levodopa treatment was initiated.