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June 1995

Factors Predictive of the Need for Levodopa Therapy in Early, Untreated Parkinson's Disease

Author Affiliations

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).

Arch Neurol. 1995;52(6):565-570. doi:10.1001/archneur.1995.00540300037010

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 (α-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.

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