A timeline for Parkinson's disease

Prior to the appearance of classical motor symptoms in Parkinson’s disease there is a prodromal period of several years duration, and once motor symptoms begin the disease may continue for up to 20 years. The clinical features of the prodromal and motor phases may correlate with pathological changes in the central and autonomic systems, thereby permitting a sequential plan of disease progression to be developed. In this article, the authors present a ‘best guess’ scenario for the progression of Parkinson’s disease in an individual presenting with symptoms in their sixties. They speculate that the disease will last approximately 40 years from the earliest non-motor symptoms to death. Appreciation of a sequence of disease progression may allow better strategies for slowing or halting the disease, or more effective clinical management.