{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:30:58Z","timestamp":1790767858170,"version":"4.1.0"},"reference-count":61,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,9]],"date-time":"2022-08-09T00:00:00Z","timestamp":1660003200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Phenotypic differences in Parkinson\u2019s Disease (PD) among locals (Emiratis) and Expatriates (Expats) living in United Arab Emirates have not been described and could be important to unravel local aspects of clinical heterogenicity of PD pointing towards genetic and epigenetic variations. Objective: To investigate the range and nature of motor and nonmotor clinical presentations of PD and its impact on time to diagnosis, local service provisions, and quality of life in Emiratis and Expats in UAE, as well as address the presence of current unmet needs on relation to care and etiopathogenesis of PD related to possible genetic and epigenetic factors. Methods: a cross-sectional one point in time prospective, observational real-life study of 171 patients recruited from PD and Neurology clinics across United Arab Emirates from 2019\u20132021. Primary outcomes were sociodemographic data, motor and nonmotor symptoms (NMS), including cognition and sleep, and quality of life (QOL) assessments, Results: A total of 171 PD patients (52 Emiratis 119 Expats) were included with mean age (Emiratis 48.5 (13.1) Expats 64.15 (13.1)) and mean disease duration (Emiratis 4.8 (3.2) Expats 6.1 (2.9)). In the Emiratis, there was a significant mean delay in initiating treatment after diagnosis (Emiratis 1.2 (0.9) Expats 1.6 (1.1)), while from a clinical phenotyping aspect, there is a high percentage of akinesia 25 (48.1) or tremor dominant (22 (42.3)) phenotypes as opposed to mixed subtype 67 (56.3) in Expat cohorts; double tremor dominant, especially Emirati females (25%), had a predominant lower limb onset PD. Both Emirati (27.9 (24.0)) and Expat 29.4 (15.6) showed moderate NMS burden and the NMS profile is dominated by Sleep, Fatigue, Mood, Emotional well-being 3.0 (1.1) and Social Stigma 3.5 (0.9) aspects of PDQ8 SI measurements are predicted worse QOL in Emiratis, while lack of social support 2.3 (1.3) impaired QOL in Expat population. Awareness for advanced therapies was low and only 25% of Emiratis were aware of deep brain surgery (DBS), compared to 69% Expats. Only 2% of Emiratis, compared to 32% of Expats, heard of Apomorphine infusion (CSAI), and no (0%) Emiratis were aware of intrajejunal levodopa infusion (IJLI), compared to 13% of expats. Conclusion: Our pilot data suggest clinical phenotypic differences in presentation of PD in Emiratis population of UAE compared to expats. Worryingly, the data also show delayed treatment initiation, as well as widespread lack of knowledge of advanced therapies in the Emirati population.<\/jats:p>","DOI":"10.3390\/jpm12081300","type":"journal-article","created":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T02:42:53Z","timestamp":1660099373000},"page":"1300","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["First Two-Year Observational Exploratory Real Life Clinical Phenotyping, and Societal Impact Study of Parkinson\u2019s Disease in Emiratis and Expatriate Population of United Arab Emirates 2019\u20132021: The EmPark Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8970-8595","authenticated-orcid":false,"given":"Vinod","family":"Metta","sequence":"first","affiliation":[{"name":"Psychology & Neuroscience, Department of Neurosciences, Institute of Psychiatry, King\u2019s College London, London, UK"},{"name":"Parkinson\u2019s Foundation Centre of Excellence, King\u2019s College Hospital, London, UK"},{"name":"Kings College Hospital London, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huzaifa","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Parkinson\u2019s Association, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1687-6587","authenticated-orcid":false,"given":"Tom","family":"Loney","sequence":"additional","affiliation":[{"name":"College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani T. S.","family":"Benamer","sequence":"additional","affiliation":[{"name":"College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Alhawai","sequence":"additional","affiliation":[{"name":"Higher Colleges of Technology, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dananir","family":"Almuhairi","sequence":"additional","affiliation":[{"name":"Parkinson\u2019s Association, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulla","family":"Al Shamsi","sequence":"additional","affiliation":[{"name":"Parkinson\u2019s Association, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sneha","family":"Mohan","sequence":"additional","affiliation":[{"name":"Kings College Hospital London, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kislyn","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Kings College Hospital London, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Mohan","sequence":"additional","affiliation":[{"name":"Kings College Hospital London, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"O\u2019Sullivan","sequence":"additional","affiliation":[{"name":"Kings College Hospital London, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Muralidharan","sequence":"additional","affiliation":[{"name":"Kings College Hospital London, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheikha","family":"Al Mazrooei","sequence":"additional","affiliation":[{"name":"Stem Cell Association, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khadeeja","family":"Dar Mousa","sequence":"additional","affiliation":[{"name":"Dubai Statistics Centre, Dubai, United Arab Emirates"},{"name":"People of Determination Council (POD) Council of Dubai Police, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Chung-Faye","sequence":"additional","affiliation":[{"name":"Psychology & Neuroscience, Department of Neurosciences, Institute of Psychiatry, King\u2019s College London, London, UK"},{"name":"Parkinson\u2019s Foundation Centre of Excellence, King\u2019s College Hospital, London, UK"},{"name":"Kings College Hospital London, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rukmini","family":"Mrudula","sequence":"additional","affiliation":[{"name":"Nizams Institute of Medical Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Falup-Pecurariu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Transilvania University of Brasov, Brasov, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3829-0675","authenticated-orcid":false,"given":"Carmen","family":"Rodriguez Bilazquez","sequence":"additional","affiliation":[{"name":"Institute of Salud Carlos 111, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Matar","sequence":"additional","affiliation":[{"name":"Genetic Disease Association, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupam","family":"Borgohain","sequence":"additional","affiliation":[{"name":"Nizams Institute of Medical Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2815-0505","authenticated-orcid":false,"given":"K. Ray","family":"Chaudhuri","sequence":"additional","affiliation":[{"name":"Psychology & Neuroscience, Department of Neurosciences, Institute of Psychiatry, King\u2019s College London, London, UK"},{"name":"Parkinson\u2019s Foundation Centre of Excellence, King\u2019s College Hospital, London, UK"},{"name":"Kings College Hospital London, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,9]]},"reference":[{"key":"ref_1","first-page":"S29","article-title":"Young onset Parkinson\u2019s disease: A modern and tailored approach","volume":"10","author":"Post","year":"2020","journal-title":"J. Park. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1742-4755-6-17","article-title":"Consanguinity and reproductive health among Arabs","volume":"6","author":"Tadmouri","year":"2009","journal-title":"Reprod. Healh"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/mds.20316","article-title":"Genetic testing in Parkinson\u2019s disease","volume":"20","author":"Hadley","year":"2005","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1159\/000110316","article-title":"A community survey of neurological disorders in Saudi Arabia: The Thuqbah study","volume":"12","author":"Bademosi","year":"1993","journal-title":"Neuroepidemiology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1159\/000279653","article-title":"LRRK2 G2019S in the North African population: A review","volume":"63","author":"Benamer","year":"2010","journal-title":"Eur. Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1212\/WNL.54.8.1603","article-title":"Clinical and genetic study of familial Parkinson\u2019s disease in Tunisia","volume":"54","author":"Belal","year":"2000","journal-title":"Neurology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/S1474-4422(20)30026-0","article-title":"Parkinson\u2019s disease in the MENASA countries","volume":"19","author":"Khalil","year":"2020","journal-title":"Lancet Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.parkreldis.2010.09.003","article-title":"LRRK2 G2019S mutation in Parkinson\u2019s disease: A neuropsychological and neuropsychiatric study in a large Algerian cohort","volume":"16","author":"Belarbi","year":"2010","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.1002\/mds.23283","article-title":"Comprehensive sequencing of the LRRK2 gene in patients with familial Parkinson\u2019s disease from North Africa","volume":"25","author":"Kachergus","year":"2010","journal-title":"Mov. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.clineuro.2009.08.010","article-title":"Prevalence of Parkinson\u2019s disease in Northern Jordan","volume":"111","author":"Alrefai","year":"2009","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Al-Mubarak, B.R., Bohlega, S.A., Alkhairallah, T.S., Magrashi, A.I., AlTurki, M.I., Khalil, D.S., AlAbdulaziz, B.S., Abou Al-Shaar, H., Mustafa, A.E., and Alyemni, E.A. (2015). Parkinson\u2019s disease in Saudi patients: A genetic study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0135950"},{"key":"ref_12","first-page":"258","article-title":"Parkinsonism in immigrant Afro-Caribbean and Indian subjects living in the United Kingdom","volume":"66","author":"Hu","year":"1999","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1002\/1531-8257(200001)15:1<18::AID-MDS1005>3.0.CO;2-Z","article-title":"Atypical parkinsonism in Afro-Caribbean and Indian origin immigrants to the UK","volume":"15","author":"Chaudhuri","year":"2000","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1001\/jamaneurol.2017.3299","article-title":"The Parkinson pandemic\u2014A call to action","volume":"75","author":"Dorsey","year":"2018","journal-title":"JAMA Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2649","DOI":"10.1002\/mds.23429","article-title":"Systematic review of levodopa dose equivalency reporting in Parkinson\u2019s disease","volume":"25","author":"Tomlinson","year":"2010","journal-title":"Mov. Disord."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1212\/WNL.50.2.318","article-title":"Parkinsonism: Onset, progression, and mortality","volume":"50","author":"Hoehn","year":"1998","journal-title":"Neurology"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ray Chaudhuri, K., Rojo, J.M., Schapira, A.H., Brooks, D.J., Stocchi, F., Odin, P., Antonini, A., Brown, R.J., and Martinez-Martin, P. (2013). A proposal for a comprehensive grading of Parkinson\u2019s disease severity combining motor and non-motor assessments: Meeting an unmet need. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0057221"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1080\/08870449708406741","article-title":"The PDQ-8: Development and validation of a short-form Parkinson\u2019s disease questionnaire","volume":"12","author":"Jenkinson","year":"1997","journal-title":"Psychol. Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1002\/mds.26270","article-title":"King\u2019s Parkinson\u2019s disease pain scale, the first scale for pain in PD: An international validation","volume":"30","author":"Chaudhuri","year":"2015","journal-title":"Mov. Disord."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/jnnp.73.6.629","article-title":"The Parkinson\u2019s disease sleep scale: A new instrument for assessing sleep and nocturnal disability in Parkinson\u2019s disease","volume":"73","author":"Chaudhuri","year":"2002","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"Mini-mental state: A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.parkreldis.2004.07.007","article-title":"The Parkinson fatigue scale","volume":"11","author":"Brown","year":"2005","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1002\/mds.22365","article-title":"Familial Parkinsonism and early onset Parkinson\u2019s disease in a Brazilian movement disorders clinic: Phenotypic characterization and frequency of SNCA, PRKN, PINK1, and LRRK2 mutations","volume":"24","author":"Camargos","year":"2009","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1212\/01.wnl.0000244345.49809.36","article-title":"Frequency of LRRK2 mutations in early-and late-onset Parkinson disease","volume":"67","author":"Clark","year":"2006","journal-title":"Neurology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1002\/mds.20933","article-title":"PINK1 homozygous W437X mutation in a patient with apparent dominant transmission of parkinsonism","volume":"21","author":"Criscuolo","year":"2006","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"365","DOI":"10.7861\/clinmedicine.16-4-365","article-title":"New concepts in the pathogenesis and presentation of Parkinson\u2019s disease","volume":"16","author":"Sauerbier","year":"2016","journal-title":"Clin. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1002\/mds.27027","article-title":"Personalized medicine in Parkinson\u2019s disease: Time to be precise","volume":"32","author":"Titova","year":"2017","journal-title":"Mov. Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1136\/jnnp.2006.098327","article-title":"A multicentre longitudinal observational study of changes in self-reported health status in people with Parkinson\u2019s disease left untreated at diagnosis","volume":"78","author":"Grosset","year":"2007","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1080\/03007995.2018.1502165","article-title":"Developing consensus among movement disorder specialists on clinical indicators for identification and management of advanced Parkinson\u2019s disease: A multi-country Delphi-panel approach","volume":"34","author":"Antonini","year":"2018","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2377-7-27","article-title":"Meta-analysis of the literature on diagnostic accuracy of SPECT in parkinsonian syndromes","volume":"7","author":"Vlaar","year":"2007","journal-title":"BMC Neurol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1136\/jnnp.55.3.181","article-title":"Accuracy of clinical diagnosis of idiopathic Parkinson\u2019s disease: A clinico-pathological study of 100 cases","volume":"55","author":"Hughes","year":"1992","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_33","unstructured":"Conditions, N.C.C.f.C. CRoyal College of Physicians."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1136\/jnnp.74.2.163","article-title":"The relative health related quality of life of veterans with Parkinson\u2019s disease","volume":"74","author":"Gage","year":"2003","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1056\/NEJM199301213280305","article-title":"Effects of tocopherol and deprenyl on the progression of disability in early Parkinson\u2019s disease","volume":"328","author":"Group","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1056\/NEJM200005183422004","article-title":"A five-year study of the incidence of dyskinesia in patients with early Parkinson\u2019s disease who were treated with Ropinirole or levodopa","volume":"342","author":"Rascol","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1937","DOI":"10.1001\/archneur.59.12.1937","article-title":"A controlled trial of Rasagiline in early Parkinson disease: The TEMPO Study","volume":"59","author":"Group","year":"2002","journal-title":"Arch. Neurol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Parkinson Study Group, and Parkinson Study Group (2002). Dopamine transporter brain imaging to assess the effects of Pramipexole vs levodopa on Parkinson disease progression. JAMA, 287, 1653\u20131661.","DOI":"10.1001\/jama.287.13.1653"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1002\/ana.10609","article-title":"Slower progression of Parkinson\u2019s disease with Ropinirole versus levodopa: The REAL-PET study","volume":"54","author":"Whone","year":"2003","journal-title":"Ann. Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2498","DOI":"10.1056\/NEJMoa033447","article-title":"Levodopa and the progression of Parkinson\u2019s disease","volume":"351","author":"Group","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1001\/jama.284.15.1931","article-title":"Pramipexole vs levodopa as initial treatment for Parkinson disease: A randomized controlled trial","volume":"284","author":"Group","year":"2000","journal-title":"JAMA"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Stowe, R., Ives, N., Clarke, C.E., Ferreira, J., Hawker, R.J., Shah, L., Wheatley, K., and Gray, R. (2008). Dopamine agonist therapy in early Parkinson\u2019s disease. Cochrane Database Syst. Rev., CD006564.","DOI":"10.1002\/14651858.CD006564.pub2"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1136\/bmj.38184.606169.AE","article-title":"Monoamine oxidase type B inhibitors in early Parkinson\u2019s disease: Meta-analysis of 17 randomized trials involving 3525 patients","volume":"329","author":"Ives","year":"2004","journal-title":"BMJ"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1056\/NEJMoa0809335","article-title":"A double-blind, delayed-start trial of Rasagiline in Parkinson\u2019s disease","volume":"361","author":"Olanow","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1002\/mds.22402","article-title":"Long-term outcome of early versus delayed Rasagiline treatment in early Parkinson\u2019s disease","volume":"24","author":"Hauser","year":"2009","journal-title":"Mov. Disord."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1002\/ana.22060","article-title":"Initiating levodopa\/carbidopa therapy with and without entacapone in early Parkinson disease: The STRIDE-PD study","volume":"68","author":"Stocchi","year":"2010","journal-title":"Ann. Neurol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1016\/S0140-6736(14)60683-8","article-title":"Long-term effectiveness of dopamine agonists and monoamine oxidase B inhibitors compared with levodopa as initial treatment for Parkinson\u2019s disease (PD MED): A large, open-label, pragmatic randomized trial","volume":"384","author":"Group","year":"2014","journal-title":"Lancet"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1136\/jnnp.69.3.308","article-title":"What contributes to quality of life in patients with Parkinson\u2019s disease?","volume":"69","author":"Schrag","year":"2000","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1002\/1531-8257(200003)15:2<216::AID-MDS1003>3.0.CO;2-#","article-title":"The quality of life in Parkinson\u2019s disease","volume":"15","author":"Kuopio","year":"2000","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1002\/mds.25664","article-title":"Health-related quality of life in early Parkinson\u2019s disease: The impact of nonmotor symptoms","volume":"29","author":"Duncan","year":"2014","journal-title":"Mov. Disord."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/S1098-3015(10)66110-4","article-title":"PNL5 Social Costs of Parkinson Disease in Italy","volume":"6","author":"Zecchinelli","year":"2004","journal-title":"Value Health"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1002\/mds.27302","article-title":"Short-and long-term cost and utilization of health care resources in Parkinson\u2019s disease in the UK","volume":"33","author":"Weir","year":"2018","journal-title":"Mov. Disord."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/S1353-8020(02)00097-4","article-title":"Economic burden and quality of life impairment increase with severity of PD","volume":"9","author":"Kaakkola","year":"2003","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jns.2010.04.011","article-title":"Trends in resource utilization for Parkinson\u2019s disease in Germany","volume":"294","author":"Winter","year":"2010","journal-title":"J. Neurol. Sci."},{"key":"ref_55","unstructured":"Richard Dodel, J.-P.R.M.B.a.W.H.O. (Rep. Touch Brief., 2008). The Economic Burden of Parkinson\u2019s Disease, Rep. Touch Brief."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Martinez-Martin, P., Rodriguez-Blazquez, C., Paz , S., Forjaz , M.J., Frades-Payo, B., Cubo, E., de Pedro-Cuesta, J., Liz\u00e1n, L., and ELEP Group (2015). Parkinson symptoms and health related quality of life as predictors of costs: A longitudinal observational study with linear mixed model analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0145310"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s002170100324","article-title":"Isolation of cyclodextrin glucanotransferase preparations of different purities","volume":"213","author":"Popova","year":"2001","journal-title":"Eur. Food Res. Technol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.parkreldis.2009.11.012","article-title":"Social and clinical determinants of quality of life in Parkinson\u2019s disease in a Russian cohort study","volume":"16","author":"Winter","year":"2010","journal-title":"Parkinsonism Relat. Disord."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1002\/mds.21360","article-title":"Predicting the cost of Parkinson\u2019s disease","volume":"22","author":"McCrone","year":"2007","journal-title":"Mov. Disord."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1002\/mds.22999","article-title":"Prevalence and cost of medication nonadherence in Parkinson\u2019s disease: Evidence from administrative claims data","volume":"25","author":"Davis","year":"2010","journal-title":"Mov. Disord."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1111\/j.1468-1331.2005.01096.x","article-title":"Effects of dyskinesias in Parkinson\u2019s disease on quality of life and health-related costs: A prospective European study","volume":"12","author":"Pechevis","year":"2005","journal-title":"Eur. J. Neurol."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/8\/1300\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:06:04Z","timestamp":1760141164000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/8\/1300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,9]]},"references-count":61,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["jpm12081300"],"URL":"https:\/\/doi.org\/10.3390\/jpm12081300","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,9]]}}}