Prognosis
Treatment of PD is symptomatic as no curative or disease-modifying agents are available. Therefore, the course is progressive. Unilateral symptoms ultimately become bilateral. Rates of progression vary between patients, with rapidly and slowly progressive forms.[15] A typical course for the slowly progressive form is as follows:
A period of 2-3 years when treatment with dopaminergic agents results in improvement in symptoms.
After 5 years of levodopa treatment, motor complications develop.
Eventually, after a number of years, the emergence of symptoms such as freezing, falling, and dementia, which do not respond to levodopa, cause significant disability.
Cognitive dysfunction was shown to be highly prevalent in the longest followed PD cohort from the Sydney multicenter study.[193]
The disease course varies between patients, with many living a normal life span. Certain features can predict a slower progression, such as tremor predominance.[194]
Factors that predict more rapid rate of progression are:[194][195]
Older age at symptom onset
Rigidity/hypokinesia as presenting symptoms (versus rest tremor)
Associated comorbidities
Decreased response to dopaminergic medications.
Cognitive dysfunction and nondopaminergic symptoms at the time of diagnosis are the main determinants of increased disability in the first 5 years of disease.[196]
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