title: Long-duration Parkinson's disease: role of lateralization of motor features.
abstract: BACKGROUND
  A mean of 10 years elapse before patients with Parkinson's disease (PD) reach Hoehn & Yahr (H&Y) stage 4, and 14 years for stage 5. A small proportion of PD patients survive and are ambulatory for ≥ 20 years. We sought to identify features associated with long-duration PD (dPD).
  
  
  METHODS
  This five-center, case-control study compared 136 PD patients with ≥ 20 years of duration and H&Y stage ≤ 4 (dPD) to 134 H&Y-, age- and gender-matched PD patients between 10 and 15 years of disease (cPD).
  
  
  RESULTS
  By study design, there were no between-group differences in age, gender and H&Y. dPD subjects were younger at onset (p < 0.0001), had more psychosis (p: 0.038), were receiving higher levodopa equivalent daily doses (p: 0.02), were predominantly left-handed (p: 0.048), and had greater frequency of left-sided onset (p: 0.015) compared to cPD subjects. Both groups had similar rates of resting tremor, dementia and REM sleep behavior disorder.
  
  
  CONCLUSIONS
  Early disease onset, left-handedness and left-sided onset are associated with long disease and ambulatory PD survival. The neurobiological basis of the prognostic value of lateralization deserves further investigation.
authors.affiliation: Movement Disorders Unit, Neurology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil. renatopuppi@yahoo.com
authors.forename: Renato P
authors.initials: RP
authors.lastname: Munhoz
authors.forename: Alberto J
authors.initials: AJ
authors.lastname: Espay
authors.forename: Francesca
authors.initials: F
authors.lastname: Morgante
authors.forename: Jie-Yuan
authors.initials: JY
authors.lastname: Li
authors.forename: Helio A
authors.initials: HA
authors.lastname: Teive
authors.forename: Emily
authors.initials: E
authors.lastname: Dunn
authors.forename: Eliza
authors.initials: E
authors.lastname: Gallin
authors.forename: Irene
authors.initials: I
authors.lastname: Litvan
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003704:Dementia / Q000150:complications; D018450:Disease Progression; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008136:Longevity / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology*; D020187:REM Sleep Behavior Disorder / Q000150:complications / Q000503:physiopathology*; D014202:Tremor / Q000150:complications
chemical_list: D007980:Levodopa