The clinical effects of Parkinson’s Disease (PD) are visually obvious, but the underlying pathology of PD is still not fully understood. In this slide deck, the course, natural history and prognosis of PD are discussed, including infographics on prodromal PD as well as the stages of PD. Observational cohorts of PD progression are also used to identify related biomarkers.

This slide deck has been developed in collaboration with the former Lundbeck International Neuroscience Foundation.

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Course, Natural History and Prognosis
Course, Natural History and Prognosis

This presentation covers course, natural history and prognosis of Parkinson’s disease. The clinical effects of Parkinson’s disease (PD) are visually obvious, but the underlying pathology of PD is still not fully understood.

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The course of Parkinson’s disease

The course of Parkinson’s disease
The course of Parkinson’s disease
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The journey of Parkinson’s disease
The journey of Parkinson’s disease

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- The clinical effects of Parkinson’s disease (PD) are visually obvious, but the underlying pathology of PD is still not fully understood.[McCann et al., 2016] PD pathology is thought to spread from brain region to …

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Clinical symptoms and time course of Parkinson’s disease progression
Clinical symptoms and time course of Parkinson’s disease progression

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- The progression of PD is generally slow, taking place over years (often many years).[Kalia & Lang, 2015] While diagnosis tends to occur with the onset of motor symptoms, this can be preceded by a long prodromal ph…

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Thresholds for the appearance of Parkinson’s disease symptoms
Thresholds for the appearance of Parkinson’s disease symptoms

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Regions of the brain that are particularly vulnerable to Lewy pathology and degeneration during the earliest phase of PD include the olfactory bulb, a critical component of the sense of smell; the locus coeruleus,…

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The therapeutic benefits of modifying the disease course
The therapeutic benefits of modifying the disease course

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- While there have been major advances in the management and reduction of PD-related symptoms, there is still no effective way of preventing or slowing the underlying neurodegeneration.[Athauda & Foltynie, 2015; Fer…

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Change in levodopa response over time – ‘wearing-off’
Change in levodopa response over time – ‘wearing-off’

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Levodopa is the major symptomatic therapy for PD and provides benefit to virtually all patients.[Obeso et al., 2000] During the so-called ‘honeymoon’ period, the effects of levodopa tend to be long-lasting and sid…

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Definitions of terms used in Parkinson’s disease
Definitions of terms used in Parkinson’s disease

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- The slide includes some basic definitions of terms used to describe the course of PD. 

References:
Hametner E, Seppi K, Poewe W. The clinical spectrum of levodopa-induced motor complications. J Neurol 2010; 257 (S…

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Drug-induced dyskinesias in Parkinson’s disease
Drug-induced dyskinesias in Parkinson’s disease

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Levodopa-induced dyskinesias cover a broad clinical spectrum of different types of involuntary movements, ranging from chorea affecting the limbs, trunk, and head, slow dystonic movements, fixed dystonic postures,…

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Relationship between levodopa administration and motor fluctuations
Relationship between levodopa administration and motor fluctuations

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- As the extent of neurodegeneration in the substantia nigra becomes greater, its capacity to produce dopamine diminishes to the point where patients require larger doses of levodopa to maintain normal function.[Jen…

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Prodromal Parkinson’s disease

Prodromal Parkinson’s disease
Prodromal Parkinson’s disease
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MDS research criteria for prodromal Parkinson’s disease
MDS research criteria for prodromal Parkinson’s disease

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- The Movement Disorder Society (MDS) research criteria for identification of prodromal PD were designed solely for research purposes since, for now at least, the lack of effective treatments that are able to halt t…

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Distribution of α-synuclein pathology in Parkinson’s disease
Distribution of α-synuclein pathology in Parkinson’s disease

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- The Lewy pathology and aggregated α-synuclein proteins associated with PD are not confined to the central nervous system (CNS); they can also be found in the peripheral nervous system at various sites around the b…

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The gastrointestinal system and Parkinson’s disease
The gastrointestinal system and Parkinson’s disease

!--?xml version="1.0" encoding="UTF-8" standalone="yes"?-- Neurons found in the enteric (gut) nervous system (ENS) require dopamine.[Rao & Gershon, 2016] Without dopamine, these neurons cannot properly control gastrointestinal motility.[Rao & Gershon, 2016] Animal studies…

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