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Determinants of the timing of symptomatic treatment in early Parkinson's Disease: The National Institutes of Health Exploratory Trials in Parkinson Disease (NET-PD) experience
Archives of Neurology, 08/13/09

Parashos SA et al. – In early Parkinson's disease (PD), greater impairment and disability and higher level of education are independently associated with an earlier need for symptomatic treatment.

• Study of predictive value of baseline measures of impairment, disability, and quality of life for timing of initiation of symptomatic treatment in early PD
• Inception cohort analysis for ambulatory population from multiple sites in United States and Canada
• Subjects: 413 pts with early, untreated PD in 2 double-blind trials assessing potential of experimental drugs to serve as disease-modifying agents in PD
• Randomization: creatine (67 pts), minocycline (66), coenzyme Q10 (71), GPI-1485 (71), placebo (138)
• Main outcome measure: time between baseline assessment and need for initiation of symptomatic treatment for PD
• Assessment of baseline variables for relation to main outcome measure: sex; age; education level; race/ethnicity; disease duration; occupational status; and these scales:
• Unified Parkinson Disease Rating Scale (UPDRS)
• Medical Outcomes Study Short Form Survey
• Modified Rankin Scale
• Schwab and England Activities of Daily Living Scale
• Total Functional Capacity Scale
• 39-item Parkinson Disease Questionnaire
• Geriatric Depression Scale scores

• Endpoint reached within 12 mo for ~50% (48.5%) of pts
• Higher baseline impairment and disability independently associated with earlier need for symptomatic treatment
• These determinants based on UPDRS III (motor section), UPDRS II (activities of daily living section, pt rating), Modified Rankin Scale scores, and education level

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