5-2-1 Criteria: A Simple Screening Tool for Identifying Advanced PD Patients Who Need an Optimization of Parkinson’s Treatment

Abstract

Objective. 5-(5 times oral levodopa tablet taken/day) 2-(2 hours of OFF time/day) 1-(1 hour/day of troublesome dyskinesia) criteria have been proposed by a Delphi expert consensus panel for diagnosing advanced Parkinson's disease (PD). e aim of the present study is to compare quality of life (QoL) in PD patients with "5-2-1 positive criteria" vs QoL in PD patients without "5-2-1 positive criteria" (defined as meeting ≥1 of the criteria). Methods. is is a cross-sectional, observational, monocenter study. ree different instruments were used to assess QoL: the 39-Item Parkinson's Disease Quality of Life Questionnaire Summary Index Score (PDQ-39SI); a subjective rating of perceived QoL (PQ-10); and the EUROHIS-QOL 8-Item Index (EUROHIS-QOL8). Results. From a cohort of 102 PD patients (65.4 ± 8.2 years old, 53.9% males; disease duration 4.7 ± 4.5 years), 20 (19.6%) presented positive 5-2-1 criteria: 6.9% for 5, 17.6% for 2, and 4.9% for 1. 37.5% (12/32) and 25% (5/20) of patients with motor complications and dyskinesia, respectively, presented 5-2-1 negative criteria. Both health-related (PDQ-39SI, 25.6 ± 14 vs 12.1 ± 9.2; p < 0.0001) and global QoL (PQ-10, 6.1 ± 2 vs 7.1 ± 1.3; p � 0.007; EUROHIS-QOL8, 3.5 ± 0.5 vs 3.7 ± 0.4; p � 0.034) were worse in patients with 5-2-1 positive criteria. Moreover, nonmotor symptoms burden (Non-Motor Symptoms Scale total score, 64.8 ± 44.8 vs 39.4 ± 35.1; p < 0.0001) and autonomy for activities of daily living (ADLS scale, 73.5 ± 13.1 vs 89.2 ± 9.3; p < 0.0001) were worse in patients with 5-2-1 positive criteria. Patient's principal caregiver's strain (Caregiver Stain Index, 4.3 ± 3 vs 1.5 ± 1.6; p < 0.0001), burden (Zarit Caregiver Burden Inventory, 28.4 ± 12.5 vs 10.9 ± 9.8; p < 0.0001), and mood (Beck Depression Inventory II, 12.2 ± 7.2 vs 6.2 ± 6.1; p < 0.0001) were worse in patients with 5-2-1 positive criteria as well. Conclusions. QoL is worse in patients meeting ≥1 of the 5-2-1 criteria. is group of patients and their caregivers are more affected as a whole. ese criteria could be useful for identifying patients in which it is necessary to optimize Parkinson's treatment.

Off Time Independently Affects Quality of Life in Advanced Parkinson’s Disease (APD) Patients but Not in Non-APD Patients: Results from the Self-Reported Japanese Quality-of-Life Survey of Parkinson’s Disease (JAQPAD) Study

“…To the best of our knowledge, this study is the first to use the 5-2-1 diagnostic criteria to assess the effect of APD on patient QoL and determine the factors that most affect QoL in a Japanese population. Patient demographic data indicated that patients with APD represented a slightly younger population compared with the non-APD group, which is not consistent with the findings of the previous OBSERVE-PD study or with another study using the 5-2-1 diagnostic criteria in Spain [23]. ese findings are also not in line with the results from a previous systematic review, which showed that older age is predictive of increasing disability [24].…”

“…Furthermore, factors that reduce QoL at each stage could be analyzed by categorizing patients into stages using the 5-2-1 criteria, which may be useful for treatment selection based on their condition. e study conducted in Spain also reported that QoL was worse in patients meeting ≥1 of the 5-2-1 criteria and suggested the usefulness of these criteria in identifying patients requiring optimization of PD treatment [23]. While the 5-2-1 criteria could be a helpful tool in identifying patients requiring a change in their clinical regimen, the definition and treatment of APD require further standardization.…”

Timely referral for advanced therapy in Parkinson’s disease. Development of a screening tool

“…[11,15] These attempts have led to the development of a simple screening tool, the so-called 5-2-1 screening criteria, to identify advanced PD patients in whom any AT may be considered. [14,16,17] According to these criteria patients who fulfil at least one of the following characteristics have advanced PD: 5 times oral levodopa tablets taken daily; 2 hours of off time per day; 1 hour of troublesome dyskinesia per day. Although these criteria are easy to use and possibly sensitive in diagnosing advanced PD,[16,17] the 5-2-1 criteria have not been developed nor tested using prospective data from routine care.…”

“…[14,16,17] According to these criteria patients who fulfil at least one of the following characteristics have advanced PD: 5 times oral levodopa tablets taken daily; 2 hours of off time per day; 1 hour of troublesome dyskinesia per day. Although these criteria are easy to use and possibly sensitive in diagnosing advanced PD,[16,17] the 5-2-1 criteria have not been developed nor tested using prospective data from routine care. An important limitation is the lack of data on the diagnostic accuracy of the 5-2-1 criteria, including a reliable estimation of the positive predictive value.…”

Geräteunterstützte Therapien bei fortgeschrittenem idiopathischem Parkinson-Syndrom

“…In den letzten Jahren wird versucht, die Indikationsstellung sowohl für die THS als auch für die Medikamentenpumpen zu operationalisieren: Patienten, die Levodopa mehr als 5-mal täglich benötigen und trotz optimaler oraler levodopa-und nicht levodopabasierter Therapien schwere, störende Off-Phasen (länger als 1-2 Stunden am Tag) haben, sollten zur fachärztlichen Beurteilung mit der Frage für eine GUT überwiesen werden, auch wenn die Krankheitsdauer kürzer als 4 Jahre ist [5][6][7]. Aufbauend auf diese Empfehlung sind neuerdings die 5-2-1-Kriterien als Screening-Tool formuliert worden [8,9]. Das heißt, wenn ein Patient mehr als 5 Einnahmezeitpunkte von Levodopa pro Tag braucht, Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen.…”