Classification of advanced stages of Parkinson's disease: translation into stratified treatments.
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.
Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-Sur-Alzette, Luxembourg. rejko.krueger@uni.lu.|Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg. rejko.krueger@uni.lu.
Rejko
R
Krüger
Molecular Neurology, University of Erlangen, Erlangen, Germany.
Jochen
J
Klucken
Department for Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, Center for Neurology, University of Tübingen, Tübingen, Germany.
Daniel
D
Weiss
Department of Neurology of the Ruhr-University Bochum at St Josef-Hospital, Gudrunstrasse 56, 44791 , Bochum, Germany.
Lars
L
Tönges
Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-Sur-Alzette, Luxembourg.|Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg.
Pierre
P
Kolber
Center of Mental Health, Clinic and Policlinic of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Würzburg, Germany.
Stefan
S
Unterecker
Nervenarztpraxis Gerresheim, Düsseldorf, Germany.
Michael
M
Lorrain
Department of Neurology, Klinikum Hanau GmbH, Hanau, Germany.
Horst
H
Baas
Department of Neurology, St. Joseph Hospital Berlin-Weissensee, Berlin, Germany.
Thomas
T
Müller
Center of Mental Health, Clinic and Policlinic of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Würzburg, Germany.
Peter
P
Riederer
D018450:Disease Progression; D006801:Humans; D010300:Parkinson Disease / Q000145:classification* / Q000628:therapy; D057285:Precision Medicine
Advanced Parkinson's disease; Invasive therapies; Personalized medicine; Stratification