Beyond "Advanced": proposing Fluctuation-Dominant Parkinson's disease as a functional alternative to enable timely...

Area of Science:

• Neurology
• Movement Disorders
• Patient-Reported Outcomes

Background:

• The label "advanced Parkinson's disease" (PD) negatively impacts patient perception and therapy referral.
• Current "early" vs. "advanced" PD terminology fails to capture the prolonged intermediate disease phase.
• This terminology creates a psychological barrier, leading eligible patients to reject beneficial device-aided therapy (DAT).

Purpose of the Study:

• To address the terminological barriers hindering DAT referral in Parkinson's disease.
• To propose a new descriptor that accurately reflects patient experience and therapeutic needs.
• To reframe the conversation from disease severity to therapeutic opportunity.

Main Methods:

• Analysis of current terminology in Parkinson's disease guidelines and patient materials.
• Conceptual proposal of a new descriptor: "fluctuation-dominant Parkinson's disease" (FD-PD).
• Discussion of the functional and psychological implications of proposed terminology shift.

Main Results:

• The term "advanced PD" is clinically imprecise, emotionally harmful, and counterproductive for therapy access.
• FD-PD accurately describes patients experiencing significant motor and non-motor fluctuations.
• FD-PD decouples therapy eligibility from overall disease burden and names the intermediate disease phase.

Conclusions:

• Replacing "advanced PD" with FD-PD can improve patient understanding and access to DAT.
• FD-PD offers a functional, mechanism-based descriptor that aligns with therapeutic goals.
• International evaluation is recommended to formally adopt FD-PD or a similar descriptor.