This may not be as gloomy as once thought. We now recognize that “subtypes” vary greatly.
An important distinction is age at onset. Forty percent of patients are of late-onset (after age 70). Fifty percent are middle-onset (aged 50 to 69 years), and only 10% are younger than 50 years at onset.
The second distinction is the “phenotype.” Only 15% have the disabling malignant form, 50% have the mild motor-predominant form, and 35% the intermediate form.
The third is the time from diagnosis to the first major milestone, meaning falls, wheelchair dependence, dementia, or residential care placement. This could be as much as 20 years for the mild form, 13 years for the intermediate form, but usually less than 7 years for the malignant form.
Last is survival after diagnosis, which was up to 28 years for the mild form, up to 20 years for the intermediate form and up to 13 years for the malignant form. But never forget that Parkinson’s is a progressive disease and that these milestones may be reached much earlier.
These distinctions matter. They help to dispel the biases in medical teaching. More importantly they provide realistic information to patients and families. The old saying of hoping for the best but preparing for the worst is still comforting.
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