An update on the management of young-onset Parkinson's disease

Abstract

In the text that follows, we review the main clinical features, genetic characteristics, and treatment options for Parkinson’s disease (PD), considering the age at onset. The clinical variability between patients with PD points at the existence of subtypes of the disease. Identification of subtypes is important, since a focus on homogenous group may lead to tailored treatment strategies. One of the factors that determine variability of clinical features of PD is age of onset. Young-onset Parkinson’s disease (YOPD) is defined as parkinsonism starting between the ages of 21 and 40. YOPD has a slower disease progression and a greater incidence and earlier appearance of levodopa-induced motor complications; namely, motor fluctuations and dyskinesias. Moreover, YOPD patients face a lifetime of a progressive disease with gradual worsening of quality of life and their expectations are different from those of their older counterparts. Knowing this, treatment plans and management of symptoms must be paid careful attention to in order to maintain an acceptable quality of life in YOPD patients.

Real-World Prescription Patterns For Patients With Young-Onset Parkinson’s Disease in China: A Trend Analysis From 2014 to 2019

“…This could be explained by the gradual decline in neurological function over time and disease progression. In addition, partly because the diagnosis of YOPD is generally based on clinical symptoms, the overall accuracy of clinical diagnosis is lower in EOPD than in later stages of PD ( Klepac et al, 2013 ). Compared to patients with late-onset PD, those with YOPD have fewer comorbidities ( Klepac et al, 2013 ).…”

“…In addition, partly because the diagnosis of YOPD is generally based on clinical symptoms, the overall accuracy of clinical diagnosis is lower in EOPD than in later stages of PD ( Klepac et al, 2013 ). Compared to patients with late-onset PD, those with YOPD have fewer comorbidities ( Klepac et al, 2013 ). The most common comorbidities in Chinese patients with YOPD are depression/anxiety and insomnia or sleep disorders, consistent with the findings of a previous report ( Willis et al, 2013 ).…”

“…Due to the specific age of onset, patients with YOPD also tend to face a certain set of physical, economic, and psychological challenges and show poor social cognition ( Calne et al, 2008 ; Wielinski et al, 2010 ; Mehanna and Jankovic, 2019 ; Seubert-Ravelo et al, 2021 ). In addition, genetic mutations are believed to contribute more toward the aetiology of YOPD than of late-onset PD ( Rissling et al, 2009 ; Klepac et al, 2013 ).…”

“…Pharmacotherapy is one of the main treatment options for patients with YOPD ( Klepac et al, 2013 ). The type of drug to be administered for patients with YOPD depends on multiple factors, and levodopa is commonly recognised as the most effective treatment ( Klepac et al, 2013 ). Even so, there are no specific pharmacotherapy-related guidelines for patients with YOPD.…”

Parkinson’s disease, treatment choice and survival over time

“…Levodopa treatment can be delayed by starting monotherapy with MAO-B- or DA treatment [9] , and neurologists advocate such strategies [10] . This is especially relevant for younger patients with slower disease progression and at risk for earlier levodopa-induced motor complications [11] .…”