Advanced Parkinson's or "complex phase" Parkinson's disease? Re-evaluation is needed

Area of Science:

• Neurology
• Neuroscience
• Movement Disorders

Background:

• Parkinson's disease (PD) is a complex motor and nonmotor disorder requiring holistic management.
• Current definitions of "advanced" Parkinson's disease (APD) are controversial and primarily motor-focused.
• Existing assessments often overlook nonmotor symptoms, which significantly impact disease progression.

Purpose of the Study:

• To address the unmet need for accurate staging in Parkinson's disease management.
• To critically evaluate current definitions of advanced Parkinson's disease.
• To propose a novel term, "complex phase" Parkinson's disease, for improved characterization.

Main Methods:

• Review of current literature on Parkinson's disease staging and management.
• Analysis of the limitations of existing definitions of advanced PD.
• Conceptual development of a multimodal approach for defining disease phases.

Main Results:

• Current definitions of APD are based on consensus and have limitations.
• Nonmotor symptoms are crucial indicators of disease advancement but are underrepresented in current assessments.
• A multimodal approach considering symptoms and biomarkers is needed.

Conclusions:

• The term "advanced" Parkinson's disease is problematic and requires re-evaluation.
• "Complex phase" Parkinson's disease is proposed as a more comprehensive descriptor.
• A multimodal, patient-centered approach is essential for accurately defining and managing advanced stages of Parkinson's disease.