Comprehensive effects of Parkinson's disease multimodal complex treatment (PD-MCT): a two-center prospective trial

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms that impair quality of life. Inpatient Parkinson's disease Multimodal Complex Treatment (PD-MCT) integrates individualized medication adjustments with intensive multiprofessional therapies and improves symptoms and functional abilities. However, evidence remains limited regarding which symptom domains benefit most and which patient characteristics predict treatment response, particularly in advanced PD and with respect to cognitive status.

This two-center, prospective cohort study included 53 adults with advanced idiopathic PD who underwent 14-21 days of inpatient PD-MCT at two centers. Inclusion criteria comprised a diagnosis of PD according to German and International Parkinson and Movement Disorder Society guidelines and the ability to walk at least 50 m with assistive devices. Patients with atypical parkinsonian syndromes or comorbidities severely affecting gait were excluded. Motor function, non-motor symptoms, cognition, and quality of life were assessed at baseline and before discharge. A 3-month follow-up evaluated symptom burden and continuation of supportive therapies. Primary outcomes were changes in motor symptom severity (ΔMDS-UPDRS-III), overall motor function (ΔMDS-UPDRS-II + III + IV), and quality of life (ΔPDQ-39).

PD-MCT significantly improved motor symptom severity (-5.2 ± 10.6), overall motor function (-10.6 ± 10.7), and quality of life (-9.3 ± 16.2). Additional benefits were observed in non-motor symptoms, cognition, mood, and functional measures. Greater baseline motor impairment and poorer quality of life predicted larger short-term improvements, while baseline cognition did not influence treatment effectiveness. Predictive modelling showed modest predictive value of baseline motor scores for changes in MDS-UPDRS-III.

These findings confirm that PD-MCT provides clinically meaningful motor, non-motor, cognitive, and quality-of-life benefits in advanced PD, with strongest effects in patients with high baseline symptom burden.