Classification of advanced stages of Parkinson’s disease: translation into stratified treatments
| Autor: | Michael Lorrain, Jochen Klucken, Daniel Weiss, Rejko Krüger, Thomas Müller, Stefan Unterecker, Horst Baas, Peter Riederer, Pierre Kolber, Lars Tönges |
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| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Decision support system medicine.medical_specialty Neurology Emerging technologies media_common.quotation_subject Clinical Neurology Disease Neurology and Preclinical Neurological Studies - Review Article 03 medical and health sciences 0302 clinical medicine Medicine Humans Precision Medicine Empowerment Biological Psychiatry media_common business.industry Invasive therapies Parkinson Disease Precision medicine Personalized medicine 3. Good health Clinical trial Psychiatry and Mental health 030104 developmental biology Advanced Parkinson's disease Risk analysis (engineering) Physical therapy Disease Progression Neurology (clinical) Stratification business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neural Transmission |
| ISSN: | 0300-9564 |
| DOI: | 10.1007/s00702-017-1707-x |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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