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Open Access 01-08-2017 | Neurology and Preclinical Neurological Studies - Review Article

Classification of advanced stages of Parkinson’s disease: translation into stratified treatments

Authors: Rejko Krüger, Jochen Klucken, Daniel Weiss, Lars Tönges, Pierre Kolber, Stefan Unterecker, Michael Lorrain, Horst Baas, Thomas Müller, Peter Riederer

Published in: Journal of Neural Transmission | Issue 8/2017

Abstract

Advanced stages of Parkinson’s disease (advPD) still impose a challenge in terms of classification and related stage-adapted treatment recommendations. Previous concepts that define advPD by certain milestones of motor disability apparently fall short in addressing the increasingly recognized complexity of motor and non-motor symptoms and do not allow to account for the clinical heterogeneity that require more personalized approaches. Therefore, deep phenotyping approaches are required to characterize the broad-scaled, continuous and multidimensional spectrum of disease-related motor and non-motor symptoms and their progression under real-life conditions. This will also facilitate the reasoning for clinical care and therapeutic decisions, as neurologists currently have to refer to clinical trials that provide guidance on a group level; however, this does not always account for the individual needs of patients. Here, we provide an overview on different classifications for advPD that translate into critical phenotypic patterns requiring the differential therapeutic adjustments. New concepts refer to precision medicine approaches also in PD and first studies on genetic stratification for therapeutic outcomes provide a potential for more objective treatment recommendations. We define novel treatment targets that align with this concept and make use of emerging device-based assessments of real-life information on PD symptoms. As these approaches require empowerment of patients and integration into treatment decisions, we present communication strategies and decision support based on new technologies to adjust treatment of advPD according to patient demands and safety.

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Title: Classification of advanced stages of Parkinson’s disease: translation into stratified treatments
Authors: Rejko Krüger
Jochen Klucken
Daniel Weiss
Lars Tönges
Pierre Kolber
Stefan Unterecker
Michael Lorrain
Horst Baas
Thomas Müller
Peter Riederer
Publication date: 01-08-2017
Publisher: Springer Vienna
Published in: Journal of Neural Transmission / Issue 8/2017
Print ISSN: 0300-9564
Electronic ISSN: 1435-1463
DOI: https://doi.org/10.1007/s00702-017-1707-x

At a glance: The STEP trials

Springer Medicine

Classification of advanced stages of Parkinson’s disease: translation into stratified treatments

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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