Tracking Motor Progression and Device-Aided Therapy Eligibility in Parkinson's Disease

Area of Science:

• Neurology
• Neuroscience
• Genetics

Background:

• Parkinson's disease (PD) motor symptom progression varies significantly.
• Device-aided therapies (DATs) like deep brain stimulation (DBS) can manage advanced PD symptoms.
• Identifying optimal timing for DATs is crucial for patient management.

Purpose of the Study:

• To characterize motor symptom progression in PD using the 5-2-1 criteria and a refined clinical definition.
• To identify eligibility for DATs in PD patients.
• To examine differences in progression and DAT eligibility across genetic PD subgroups.

Main Methods:

• Analysis of 1205 individuals (sporadic and genetic PD) from the Parkinson's Progression Markers Initiative.
• Kaplan-Meier analysis to estimate time to meeting 5-2-1 criteria and stricter DAT eligibility criteria.
• Assessment of therapy initiation, clinical suitability, and contraindications in sporadic PD; genetic subgroup analyses.

Main Results:

• 27.3% of sporadic PD patients met the 5-2-1 criteria by 8.2 years; 18.6% met stricter DAT eligibility criteria by 12 years.
• Only 25% of those meeting 5-2-1 criteria initiated DATs within 6.8 years; most had no contraindications.
• GBA and SNCA carriers met criteria earlier; LRRK2 carriers were more likely to initiate therapy, PRKN carriers less likely.

Conclusions:

• Eligibility for DATs in Parkinson's disease is common but underutilized.
• There are missed opportunities in initiating device-aided therapies.
• Genotype-informed treatment planning may support earlier and more effective DAT initiation in PD.