TY - JOUR
T1 - Factors Predictive of the Need for Levodopa Therapy in Early, Untreated Parkinson's Disease
AU - Mcdermott, Michael P.
AU - Jankovic, Joseph
AU - Carter, Julie
AU - Fahn, Stanley
AU - Gauthier, Serge
AU - Goetz, Christopher G.
AU - Golbe, Lawrence I.
AU - Koller, William
AU - Lang, Anthony E.
AU - Olanow, C. Warren
AU - Shoulson, Ira
AU - Stern, Matthew B.
AU - Tanner, Caroline M.
AU - Weiner, William J.
N1 - Funding Information:
ThisstudywassupportedprimarilybyaPublicHealth ServicegrantNS24778fromtheNationalInstitutesofHealth, Bethesda, Md; by the General Clinical Research Centers of NYRRtheNationalInstitutesoftheHealthatColumbiaUniversity,Char-New York, (grant 00645), University ofVirginia, lottesville (grant RR 00847), the University ofPennsylvania, Philadelphia(grantRR00040),theUniversityofIowa,Iowa City(grantRR00059),OhioStateUniversity,Columbus(RR 00034),MassachusettsGeneralHospital,Boston(grantRR 01066), the University ofRochester (NY) (grant RR 00044), Brown University, Providence, RI (RR 02038), Oregon Health SciencesUniversity,Portland(grantRR00334),BaylorCol¬ lege ofMedicine, SanHouston,Tex (grantRRTheRR 00350),the Uni¬ versity ofCalifornia, Diego (grant 00827), Johns Hopkins University, Baltimore,Md(grantRR00035),the University ofMichigan, StMoAnn Arbor(grant RRRR00042), and WashingtonUniversity,Louis,(grant00036);by theParkinson'sDiseaseFoundationat Columbia-Presbyterian MedicalCenter,NewYork; bytheNationalParkinsonFoun¬ dation, Miami, Fla; by the Parkinson Foundation ofCanada, cago,111;bytheAmericanToronto,Ontario;by Parkinson'sDiseaseAssociation,the UnitedParkinsonFoundation,Chi¬
PY - 1995/6
Y1 - 1995/6
N2 - To identify characteristics of patients with early, untreated Parkinson's disease that are the most important predictors of rapid functional decline. Prospective observational study of a cohort of 800 patients with early, untreated Parkinson's disease who were involved in a multicenter, randomized, double-blind, controlled clinical trial of selegiline hydrochloride (l-deprenyl) and vitamin E (α-tocopherol). Time from randomization to the onset of disability that necessitated levodopa therapy (end point), as judged by the enrolling investigator. Stepwise Cox regression was used in combination with clinical judgment to identify the most important independent baseline predictors of the primary end point among a host of variables, including treatment with selegiline and vitamin E, global and specific clinical measures of disease severity, demographic variables, and neuropsychological test results. In addition to selegiline treatment and global disease severity measures, such as the stage according to the criteria of Hoehn and Yahr, impaired domestic capacity, and the activities of daily living score, the complex of postural instability/gait difficulty and bradykinesia were found to be the factors that were most highly associated with the risk of reaching the end point. The findings suggest that patients with Parkinson's disease whose early clinical presentation includes either postural instability/gait difficulty or bradykinesia are at high risk for rapid functional decline.
AB - To identify characteristics of patients with early, untreated Parkinson's disease that are the most important predictors of rapid functional decline. Prospective observational study of a cohort of 800 patients with early, untreated Parkinson's disease who were involved in a multicenter, randomized, double-blind, controlled clinical trial of selegiline hydrochloride (l-deprenyl) and vitamin E (α-tocopherol). Time from randomization to the onset of disability that necessitated levodopa therapy (end point), as judged by the enrolling investigator. Stepwise Cox regression was used in combination with clinical judgment to identify the most important independent baseline predictors of the primary end point among a host of variables, including treatment with selegiline and vitamin E, global and specific clinical measures of disease severity, demographic variables, and neuropsychological test results. In addition to selegiline treatment and global disease severity measures, such as the stage according to the criteria of Hoehn and Yahr, impaired domestic capacity, and the activities of daily living score, the complex of postural instability/gait difficulty and bradykinesia were found to be the factors that were most highly associated with the risk of reaching the end point. The findings suggest that patients with Parkinson's disease whose early clinical presentation includes either postural instability/gait difficulty or bradykinesia are at high risk for rapid functional decline.
UR - http://www.scopus.com/inward/record.url?scp=0029035622&partnerID=8YFLogxK
U2 - 10.1001/archneur.1995.00540300037010
DO - 10.1001/archneur.1995.00540300037010
M3 - Article
C2 - 7763203
AN - SCOPUS:0029035622
SN - 0003-9942
VL - 52
SP - 565
EP - 570
JO - Archives of Neurology
JF - Archives of Neurology
IS - 6
ER -