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Cited by 1,050Parkinson's Disease Mechanisms and TreatmentsNeurological disorders and treatmentsDementia and Cognitive Impairment Research

Sydney multicenter study of Parkinson's disease: Non‐L‐dopa–responsive problems dominate at 15 years

Hely, Mariese A., Morris, John G.L., Reid, Wayne G.J., Trafficante, Robert·2005·Movement Disorders
DOI 10.1002/mds.20324
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Abstract

One‐third of the 149 people recruited 15 to 18 years ago in the Sydney Multicenter Study of Parkinson's disease have survived. The original study compared low‐dose levodopa with low‐dose bromocriptine. We now report the problems experienced by people who survive 15 years from diagnosis. The standardized mortality ratio is significantly elevated at 1.86 and is not significantly different between treatment arms. Falls occur in 81% of patients, and 23% sustained fractures. Cognitive decline is present in 84%, and 48% fulfill the criteria for dementia. Hallucinations and depression are experienced by 50%. Choking has occurred in 50%, symptomatic postural hypotension in 35%, and urinary incontinence in 41%. No patient is still employed, and 40% of patients live in aged care facilities. Although approximately 95% have experienced L‐dopa–induced dyskinesia/dystonia and end of dose failure of medication, in the majority, these symptoms are not disabling. Dyskinesia and dystonia were delayed by early use of bromocriptine, but end‐of‐dose failure appeared at a similar time once L‐dopa was added. The rate of disease progression is similar in both arms of the study. We conclude that the most disabling long‐term problems of Parkinson's disease relate to the emergence of symptoms that are not improved by L‐dopa. Neuroprotective interventions in Parkinson's disease should be judged by their ability to improve non‐L‐dopa–responsive aspects of the disease, rather than just by their capacity to delay the introduction of L‐dopa or reduce its associated side effects. © 2004 Movement Disorder Society

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Authors
Hely, M. A., Morris, J. G. L., Reid, W. G. J., & Trafficante, R.
Affiliations
  • Westmead Hospital (AU)
  • Covance (Australia) (AU)
ORCID
Morris, John G.L.
Venue
Movement Disorders
Publisher
Wiley
Published
2004-11-18
Volume
20
Issue
2
Pages
190-199
ISSN
  • 0885-3185 (ISSN-L)
  • 1531-8257
DOI
10.1002/mds.20324
OpenAlex
W1999018495
Cited by
1,050
References
68
Citations by year
2026: 19 · 2025: 25 · 2024: 44 · 2023: 44 · 2022: 57 · 2021: 51 · 2020: 53 · 2019: 60 · 2018: 61 · 2017: 57 · 2016: 60 · 2015: 57 · 2014: 70 · 2013: 79 · 2012: 50
FWCI
13.02
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Movement Disorders (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Sandoz Australia
  • Hennessey Bequest, administered by the Australian Brain Foundation
  • Sarah Peters, administered by the Royal North Shore Hospital
  • Westmead Movement Disorder Foundation
Topics
  • Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
  • Health Sciences › Medicine › Neurology › Neurological disorders and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
Parkinson's disease, long-term outcomes, levodopa, bromocriptine, standardized mortality ratio, falls and fractures, cognitive decline, dementia, dyskinesia, orthostatic hypotension, urinary incontinence, choking, disease progression, neuroprotection
MeSH terms
Aged, Aged, 80 and over, Antiparkinson Agents, Bromocriptine, Dementia, Dose-Response Relationship, Drug, Employment, Female, Follow-Up Studies, Humans, Levodopa, Male, Middle Aged, Mortality, Movement Disorders, Neurologic Examination, Neuropsychological Tests, Parkinson Disease, Time Factors, Multicenter Studies as Topic, Disease Progression

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