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PD – Prognostic Factors — SCE Neurology MCQ

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ModerateMovement DisordersPD – Prognostic FactorsSCE Neurology

A 65-year-old man with Parkinson's disease asks about the long-term prognosis. He has had PD for 2 years and responds well to levodopa. He has no cognitive impairment. What are the main factors that predict a worse long-term prognosis in PD?

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Correct answer: D — Older age at onset, PIGD-dominant motor subtype, early cognitive impairment, early autonomic dysfunction, poor initial levodopa response, and rapid motor progression in the first 5 years

Worse prognostic factors in PD include: older age at onset, PIGD-dominant subtype (vs tremor-dominant), early cognitive impairment or dementia, early prominent autonomic dysfunction, poor or waning levodopa response, rapid motor progression in the first 5 years (high UPDRS slope), low education level, and comorbidities. Tremor-dominant PD and younger onset are associated with slower progression and better prognosis. A: Tremor-dominant has a better prognosis. C: Male sex may be slightly worse. D: Younger onset is generally better. E: Family history does not strongly predict prognosis.

Reference: NICE NG71; Jankovic et al. PD Prognosis