"Advanced" Parkinson's disease: A review.

There is no consensus driven definition of "advanced" Parkinson's disease (APD) currently. APD has been described in terms of emergence of specific clinical features and clinical milestones of the disease e.g., motor fluctuations, time to increasing falls, emergence of cognitive decline, etc. The pathological burden of disease has been used to characterize various stages of the disease. Imaging markers have been associated with various motor and nonmotor symptoms of advancing disease. In this review, we present an overview of clinical, pathologic, and imaging markers of APD. We also propose a model of disease definition involving longitudinal assessments of these markers as well as quality of life metrics to better understand and predict disease progression in those with Parkinson's disease.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sana Aslam reports a relationship with Davis Phinney Foundation that includes: funding grants. Sana Aslam reports a relationship with Barrow Neurological Foundation that includes: funding grants. Ashley Stokes reports a relationship with Eli Lilly and Company that includes: consulting or advisory. Fredric Manfredsson reports a relationship with nVector that includes: equity or stocks. Fredric Manfredsson reports a relationship with CavGene Therapeutics that includes: equity or stocks. Fredric Manfredsson reports a relationship with Neuralina Therapeutics that includes: equity or stocks. Fredric Manfredsson reports a relationship with REGENXBIO Inc that includes: funding grants. Fredric Manfredsson reports a relationship with Aspen Neuroscience that includes: funding grants. Fredric Manfredsson reports a relationship with Seelos Therapeutics that includes: funding grants. Holly Shill reports a relationship with Transposon Therapeutics Inc that includes: funding grants. Holly Shill reports a relationship with Parkinson Study Group that includes: funding grants. Holly Shill reports a relationship with Parkinson's Foundation that includes: funding grants. Holly Shill reports a relationship with National Institute of Neurological Disorders and Stroke that includes: funding grants. Holly Shill reports a relationship with Supernus Pharmaceuticals Inc that includes: funding grants. Holly Shill reports a relationship with The Michael J Fox Foundation that includes: funding grants. Holly Shill reports a relationship with Cavion that includes: funding grants. Holly Shill reports a relationship with Barrow Neurological Foundation that includes: funding grants. Holly Shill reports a relationship with Cerevel Therapeutics Inc that includes: funding grants. Holly Shill reports a relationship with Parkinson Study Group Nq that includes: consulting or advisory. Holly Shill reports a relationship with Biogen that includes: consulting or advisory. Holly Shill reports a relationship with AbbVie Inc that includes: consulting or advisory. Holly Shill reports a relationship with SAGE Therapeutics Inc that includes: consulting or advisory. Holly Shill reports a relationship with Praxis Precision Medicines Inc that includes: consulting or advisory. Holly Shill reports a relationship with KeifeRx that includes: consulting or advisory. Fredric Manfredsson has patent issued to Fredric Manfredsson. Ad-hoc reviewer for PRD. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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