Evaluation of Motor Complications in Parkinson’s Disease: Understanding the Perception Gap between Patients and Physicians

Abstract

Background. Patients with Parkinson’s disease (PD) receiving levodopa treatment often report motor complications including wearing-off (WO), dyskinesia, and morning akinesia. As motor complications are associated with a decrease in patients’ quality of life (QoL), it is important to identify their occurrence and commence immediate management. This study investigated whether differences in the perception of motor complications exist between patients and their physicians in routine clinical practice. Methods. After an Internet-based screening survey, questionnaires were distributed to physicians and their patients in Japan. The 9-item Wearing-Off Questionnaire (WOQ-9) was used to objectively assess the presence of WO; patients with WOQ-9 scores ≥2 were considered to have WO. McNemar’s test was used to compare physician assessment versus WOQ-9 scores, patient self-awareness versus physician assessment, and patient self-awareness versus WOQ-9, separately. Morning akinesia and dyskinesia were assessed by both physician assessment and patient self-awareness with McNemar’s test. QoL was assessed using the 8-item Parkinson’s Disease Questionnaire (PDQ-8) with the Wilcoxon rank-sum test. Results. A total of 235 patients with PD and their 92 physicians participated in this survey. A significant discordance was observed between the WOQ-9 and physician assessment of WO (67.2% vs 46.0%; p < 0.0001 ). Furthermore, patient self-awareness of WO was 35.3% ( p = 0.0004 , vs physician). Morning akinesia (patient, 58.7%; physician, 48.9%; p = 0.0032 ), dyskinesia (patient, 34.0%; physician, 23.4%; p = 0.0006 ), and bodily discomfort (patient, 25.0; physician, 0.0; p = 0.0102 ) of QoL were underrecognized by physicians. Conclusions. This study investigated differences in the perception of WO between patients with PD and their physicians in routine clinical practice and highlighted that patients have a low awareness of the symptoms of WO compared with physician assessments and WOQ-9. Conversely, morning akinesia, dyskinesia, and bodily discomfort were underrecognized by physicians.

Long-term effects of safinamide adjunct therapy on levodopa-induced dyskinesia in Parkinson’s disease: post-hoc analysis of a Japanese phase III study

“…However, the results of this study should be interpreted with caution because UPDRS Part IV and ADR were clinician-reported, while ON-TD and ON-WOTD were patient-reported using 24-h symptom diaries. In fact, a gap between physician assessment and patient self-awareness concerning the presence of dyskinesia has been recently reported (Ogura et al 2021 ).…”

“…In fact, a gap AE adverse event, FAS full analysis set, pre-D pre-existing dyskinesia, SE standard error, UPDRS unified Parkinson's disease rating scale a The dose was increased from 50 mg/day to 100 mg/day from Week 4 if there were no safety concerns, the therapeutic response to 50 mg/day was poor, and the subject wanted to increase the dose. Subsequently, the dose could be decreased to 50 mg/day if AEs attributable to excessive dopamine action made it difficult to continue the study and AEs did not improve even after reducing the dose of a levodopa combination drug b Duration of dyskinesia between physician assessment and patient self-awareness concerning the presence of dyskinesia has been recently reported (Ogura et al 2021).…”

“…As safinamide inhibits the degradation of dopamine by inhibiting MAO-B (Kurihara et al 2021) and an excess of dopamine causes dyskinesia, it is considered that a slight increase in ON-TD during the initial treatment phase is caused by the dopaminergic action of safinamide. Nonetheless, dyskinesia was not reported to worsen in the long term.…”

“…Safinamide is a selective and reversible MAO-B inhibitor approved as an add-on therapy for patients with PD who are experiencing motor fluctuations with levodopa (Kurihara et al 2021). In addition to MAO-B inhibition, safinamide modulates glutamate release by inhibiting sodium channels in vivo (Morari et al 2018).…”

Lycium barbarum polysaccharide improves dopamine metabolism and symptoms in an MPTP-induced model of Parkinson’s disease

“…Moreover, peripheral catecholamine-O-methyltransferase inhibitors reduce the systemic metabolism of LD, but some drugs need to be combined with LD to have an effect [23]. As the disease progresses, there is an emergence of complications related to long-term symptomatic treatment, including motor and non-motor fluctuations, dyskinesia, and psychosis [24][25][26][27][28].…”