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Factors Predictive of the Need for Levodopa Therapy in Early, Untreated Parkinson's Disease
Michael P. McDermott, PhD;
Joseph Jankovic, MD;
Julie Carter, RN;
Stanley Fahn, MD;
Serge Gauthier, MD;
Christopher G. Goetz, MD;
Lawrence I. Golbe, MD;
William Koller, MD, PhD;
Anthony E. Lang, MD;
C. Warren Olanow, MD;
Ira Shoulson, MD;
Matthew B. Stern, MD;
Caroline M. Tanner, MD;
William J. Weiner, MD;
Parkinson Study Group
Arch Neurol. 1995;52(6):565-570.
Abstract
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Objective
To identify characteristics of patients with early, untreated Parkinson's disease that are the most important predictors of rapid functional decline.
Design
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 ( -tocopherol).
Primary Outcome Variable
Time from randomization to the onset of disability that necessitated levodopa therapy (end point), as judged by the enrolling investigator.
Methods
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.
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.
Conclusions
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.
Author Affiliations
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From the Departments of Biostatistics (Dr McDermott) and Neurology (Dr. Shoulson), University of Rochester (NY) Medical Center; Department of Neurology, Baylor College of Medicine, Houston, Tex (Dr Jankovic); Department of Neurology, Oregon Health Sciences University, Portland (Ms Carter); Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY (Dr Fahn); The McGill Centre for Studies in Aging, St Mary's Hospital Center, Montreal, Quebec (Dr Gauthier); Department of Neurological Sciences, Rush-Presbyterian-St Luke's Medical Center, Chicago, III (Dr Goetz); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick (Dr Golbe); Department of Neurology, University of Kansas Medical Center, Kansas City (Dr Koller); Department of Medicine (Neurology), The Toronto (Ontario) Hospital Western Division (Dr Lang); Department of Neurology, Mt Sinai Hospital, New York, NY (Dr Olanow); Department of Neurology, University of Pennsylvania, Philadelphia (Dr Stern); The Parkinson's Institute, Sunnyvale, Calif (Dr Tanner); and the Department of Neurology, University of Miami (Fia) (Dr Weiner).
Footnotes
Accepted for publication October 12, 1994.
This study was supported primarily by a Public Health Service grant NS 24778 from the National Institutes of Health, Bethesda, Md; by the General Clinical Research Centers of the National Institutes of Health at Columbia University, New York, NY (grant RR 00645), the University of Virginia, Charlottesville (grant RR 00847), the University of Pennsylvania, Philadelphia (grant RR 00040), the University of Iowa, Iowa City (grant RR 00059), Ohio State University, Columbus (RR 00034), Massachusetts General Hospital, Boston (grant RR 01066), the University of Rochester (NY) (grant RR 00044), Brown University, Providence, RI (RR 02038), Oregon Health Sciences University, Portland (grant RR 00334), Baylor College of Medicine, Houston, Tex (grant RR 00350), the University of California, San Diego (grant RR 00827), The Johns Hopkins University, Baltimore, Md (grant RR 00035), the University of Michigan, Ann Arbor (grant RR 00042), and Washington University, St Louis, Mo (grant RR 00036); by the Parkinson's Disease Foundation at Columbia-Presbyterian Medical Center, New York; by the National Parkinson Foundation, Miami, Fla; by the Parkinson Foundation of Canada, Toronto, Ontario; by the United Parkinson Foundation, Chicago, 111; by the American Parkinson's Disease Association, New York, NY; by the University of Rochester; and by a Neuroscience Award to the University of Rochester from the Pew Charitable Trusts, Philadelphia.
Reprint requests to Department of Biostatistics, University of Rochester Medical Center, 601 Elmwood Ave, Box 630, Rochester, NY 14642 (Dr McDermott).
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