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oai:repisalud.isciii.es:20.500.12105/145272025-04-01T12:21:43Zcom_20.500.12105_2052com_20.500.12105_2051col_20.500.12105_19608

00925njm 22002777a 4500 dc Titova, Nataliya author Martínez-Martín, Pablo author Katunina, Elena author Chaudhuri, Kallol Ray author 2017-12 Holistic management of Parkinson's disease, now recognised as a combined motor and nonmotor disorder, remains a key unmet need. Such management needs relatively accurate definition of the various stages of Parkinson's from early untreated to late palliative as each stage calls for personalised therapies. Management also needs to have a robust knowledge of the progression pattern and clinical heterogeneity of the presentation of Parkinson's which may manifest in a motor dominant or nonmotor dominant manner. The "advanced" stages of Parkinson's disease qualify for advanced treatments such as with continuous infusion or stereotactic surgery yet the concept of "advanced Parkinson's disease" (APD) remains controversial in spite of growing knowledge of the natural history of the motor syndrome of PD. Advanced PD is currently largely defined on the basis of consensus opinion and thus with several caveats. Nonmotor aspects of PD may also reflect advancing course of the disorder, so far not reflected in usual scale based assessments which are largely focussed on motor symptoms. In this paper, we discuss the problems with current definitions of "advanced" PD and also propose the term "complex phase" Parkinson's disease as an alternative which takes into account a multimodal symptoms and biomarker based approach in addition to patient preference. J Neural Transm (Vienna). 2017 Dec;124(12):1529-1537. 10.1007/s00702-017-1799-3 1435-1463 Journal of Neural Transmission (Vienna, Austria: 1996) 29116411 http://hdl.handle.net/20.500.12105/14527 Parkinson’s disease Advanced Complex Nonmotor symptoms Personalised medicine Nonmotor subtypes Advanced Parkinson's or "complex phase" Parkinson's disease? Re-evaluation is needed