Early DEtection of wEaring off in Parkinson disease: The DEEP study

Stocchi, Fabrizio; Antonini, Angelo; Barone, Paolo; Tinazzi, Michèle; Zappia, Mario; Onofrj, Marco; Ruggieri, Stefano; Morgante, Francesca; Bonuccelli, Ubaldo; Lopiano, Leonardo; Pramstaller, Peter P.; Albanese, Alberto; Attar, Mahmood; Posocco, V.; Colombo, Delia; Abbruzzese, Giovanni

doi:10.1016/j.parkreldis.2013.10.027

Cited by 130 publications

(162 citation statements)

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“…This finding contrasts with the results of Stocchi et al. (Stocchi et al., 2014); in which more than half of patients under levodopa therapy for 1 to 2 years were diagnosed as having wearing‐off symptoms, whereas only a minority of patients under levodopa ≤2.5 years had motor fluctuations in our study. Discrepancies in results could be caused by the variability in cohorts or by differing methodology of assessment.…”

Section: Discussionmentioning

confidence: 58%

“…MDS‐UPDRS Part IV was used in our study, whereas Stocchi et al. used a patient‐assessed 19‐item Wearing‐off Questionnaire with the aim to detect wearing‐off symptoms in early stages of PD (Stocchi et al., 2014). …”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown the prevalence of motor complications to increase with the duration of the disease (Nicoletti et al., 2016; Hashim et al., 2014; Schrag & Quinn, 2000; Scott, Macleod, & Counsell, 2016; García‐Ruiz, Del Val, Fernández, & Herranz, 2012; Stocchi et al., 2014). Motor complications may affect more than half of patients within 5 years of diagnosis (Bjornestad et al., 2016) and by the end of the first decade, up to 90% of patients may exhibit dyskinesia and 60% motor fluctuations (García‐Ruiz et al., 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Other variables that potentially increase the risk for motor complications have been reported: younger age at onset (Hashim et al., 2014; García‐Ruiz et al., 2012; Bjornestad et al., 2016; Warren Olanow et al., 2013), female gender (Yoritaka et al., 2013; Larsen et al., 2000; Schrag & Quinn, 2000; Scott et al., 2016; Bjornestad et al., 2016), initial treatment with levodopa (Schrag & Quinn, 2000; García‐Ruiz et al., 2012), and a higher score on the Unified Parkinson's Disease Rating Scale (UPDRS) Part II (Stocchi et al., 2014; Warren Olanow et al., 2013). Additionally, a low body weight (Warren Olanow et al., 2013) presence of tremor at diagnosis (Scott et al., 2016), higher levodopa equivalent dose, (Nicoletti et al., 2016) and higher MMSE score (Scott et al., 2016) have been shown to predict a higher rate of dyskinesias, while younger age (Stocchi et al., 2014; Bjornestad et al., 2016) and UPDRS Part III score (Bjornestad et al., 2016) predict a higher rate of motor fluctuations.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, a low body weight (Warren Olanow et al., 2013) presence of tremor at diagnosis (Scott et al., 2016), higher levodopa equivalent dose, (Nicoletti et al., 2016) and higher MMSE score (Scott et al., 2016) have been shown to predict a higher rate of dyskinesias, while younger age (Stocchi et al., 2014; Bjornestad et al., 2016) and UPDRS Part III score (Bjornestad et al., 2016) predict a higher rate of motor fluctuations.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with motor complications in Parkinson's disease

et al. 2017

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ObjectivesLevodopa is the most effective therapy for treating Parkinson's disease (PD); however, side effects such as dyskinesias and motor fluctuations may occur after some years of its usage. The aims of this study were to assess the frequency of and factors associated with motor complications among PD patients on levodopa treatment.MethodsIn a cross‐sectional study carried out in 2010–2013, clinical data and treatment details were collected. Logistic regression expressed by odd ratios (OR) and 95% confidence intervals (CI) was conducted to examine the effects of several independent variables on the occurrence of motor complications.ResultsA total of 455 patients were enrolled, among whom 374 were on levodopa. Analysis was performed in 328 patients whose exact duration of levodopa treatment was known. Among patients included in the analysis, 25.9% experienced motor complications; of these, 21% had dyskinesias and 20.1% had motor fluctuations. Based on logistic regression, statistically significant factors associated with the occurrence of motor complications were younger age at onset of the disease, higher levodopa equivalent daily dose (LEDD), shorter time to levodopa initiation, and akinetic‐rigid dominant phenotype of PD.ConclusionsThis study suggests that postponing the start of levodopa therapy and maintaining low daily doses of levodopa might reduce the risk of motor complications. Our results confirm that due to higher risk of motor complications, effectively treating patients with akinetic‐rigid dominant phenotype of PD might be more challenging than for patients whose dominant symptom is tremor.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors associated with motor complications in Parkinson's disease

et al. 2017

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Understanding, Impact, and Communication of “Off” Periods in Parkinson's Disease: A Scoping Review

Rastgardani

Armstrong

Gagliardi

et al. 2018

Movement Disord Clin Pract

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Background Off periods are a common and disabling symptom of Parkinson's disease. We reviewed published research on understanding, impact, and communication regarding off periods to identify issues warranting further research. Methods We performed a scoping review, searching MEDLINE, EMBASE, Cochrane Library, CINAHL, and PsycINFO from 2006 to January 2018 for studies examining the impact of, understanding of, or communication about off periods. Results Twenty‐six papers met eligibility criteria. Twenty‐three studies evaluated the impact or experience of off periods in patients, three evaluated the impact upon carepartners, two papers addressed understanding of off periods, one study evaluated communication about off periods, and three studies evaluated a facilitator of communication about off periods. The findings indicate that (1) off periods are among the most troublesome symptoms to patients and that their impact on activities is broad; (2) the understanding of off periods by patients, carepartners, and nurses may be suboptimal; and (3) questionnaires hold promise as a mechanism for facilitating communication given the findings that they may enhance the detection of off periods and are rated as useful by physicians. No studies evaluated interventions to promote knowledge about off periods, and no studies identified barriers of communication about off periods. Conclusions There is a paucity of knowledge regarding the lived experiences of off periods, particularly for carepartners. Additionally, little knowledge exists in the literature regarding understanding of and communication about off periods between patients or carepartners and treating physicians. Further research is required to explore these issues to ultimately improve the treatment of off periods.

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The Most Bothersome Aspects of Off Periods Reported by Individuals with Parkinson's Disease

Chahine

Edison

Daeschler

et al. 2020

Movement Disord Clin Pract

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Introduction The off periods in Parkinson's disease have a significantly negative impact on quality of life. What the most bothersome aspects of off periods are from the patient's perspective are not well studied, nor is the degree to which screening tools for wearing off such as the Wearing Off Questionnaires (WOQs) capture what bothers patients most. Methods A questionnaire was deployed to eligible participants of Fox Insight, an online study of individuals with self‐reported Parkinson's disease. Inclusion criteria were the use of ≥1 dopaminergic medications and an affirmative response to a question on experiencing off periods. Participants provided free‐text responses regarding the top 3 most bothersome symptoms they experience when off. A determination was made regarding whether each response would have been captured by the 32‐item, 19‐item, and 9‐item WOQs. Results The final sample had 2106 participants, a mean age of 66.6 years, 52.3% were men, and had a disease duration of 4.9 years. The WOQ‐32 items covered all of the most bothersome symptoms for 53.2% of respondents. Among bothersome aspects of off not captured by the WOQs, 597 (66.2%) were specific symptoms, with freezing of gait, apathy, and memory problems being the most common. The functional consequences of off periods were most bothersome to 232 (25.7%), with walking problems being the most common. The emotional response to off periods was the most bothersome aspect to 169 respondents (18.7%). Discussion This study emphasizes the value of narrative data in understanding patient experiences, and what bothers patients most about off periods. The WOQs, although of established utility in the screening for wearing off, may not capture those symptoms most bothersome to patients.

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Early DEtection of wEaring off in Parkinson disease: The DEEP study

Abstract: WO is common already at the early stages of PD and is underestimated by routine neurological clinical evaluation. The number of WO symptoms, both motor and non motor, increases along with disease duration and has a negative impact on patients QoL.

Cited by 130 publications

References 28 publications

Factors associated with motor complications in Parkinson's disease

Factors associated with motor complications in Parkinson's disease

Understanding, Impact, and Communication of “Off” Periods in Parkinson's Disease: A Scoping Review

The Most Bothersome Aspects of Off Periods Reported by Individuals with Parkinson's Disease

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