Currently, Parkinson disease (PD) can be symptomatically controlled with standard treatments; however, after a few years this response typically declines. The authors carried out a prospective practice-based study to evaluate the evolution and motor complications during the first 5 years in 59 de novo PD patients. They observed a significant improvement in UPDRS scores during the first year, then the UPDRS mean score declined progressively, especially after the third year (UPDRS score at baseline, 27 points; year 1, 19 points; year 2, 20.3 points; year 3, 22.6 points; year 4, 24.9 points; year 5, 29.5 points). Motor fluctuations, dyskinesias, and freezing also increased after year 3 from 10%, 16%, and 8% respectively to 35%, 32%, and 27% at year 5. At 5 years, 50% of patients (30 of 59) still had UPDRS scores better or equal to baseline, and 44% (26 of 59) had no motor complications. This latter group represented 38% of those subjects initially treated with levodopa and 52% initially treated with other agents.