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Li X, Dong ZY, Dong M, Chen L. Early dopaminergic replacement treatment initiation benefits motor symptoms in patients with Parkinson's disease. Front Hum Neurosci 2024; 18:1325324. [PMID: 38807633 PMCID: PMC11131585 DOI: 10.3389/fnhum.2024.1325324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 04/29/2024] [Indexed: 05/30/2024] Open
Abstract
Background Parkinson's disease (PD) generally progresses slowly, but it is controversial whether delaying treatment accelerates the progression. Objective Determine the correlation between the time of dopaminergic replacement treatment initiation and the severity of clinical symptoms in PD, including motor and non-motor symptoms. Methods PD patients were divided between 155 people who were diagnosed de novo and 165 PD patients receiving dopamine replacement therapy. Basic patient characteristics included gender, age, age at onset, disease duration, and the time of dopaminergic replacement treatment initiation. We used MDS-UPDRS scores to evaluate the severity of motor symptoms and we also used the scale to assess the severity of non-motor symptoms such as cognition, mood, sleep, and quality of life. Results The mean time between symptom onset and the initiation of drug treatment was 31.0 (22.5) months. After adjusting for age, sex, age at onset, and disease duration, we found that the MDS-Unified Parkinson's Disease Rating Scale (UPDRS)-III score increased faster in the de novo group with a similar disease duration (F = 8.7, p = 0.0034) than the treatment group. The cumulative incidence of progression to H-Y score 3 in de novo PD group over disease duration was 39.7% in 50months and 92.2% in 100 months, while in treated group such cumulative incidence was 15.5% in 50 months, 51.4% in 100 months and 81.5% in 150 months. The cumulative incidence of patients in the de novo PD group was higher than that in the treated group (p = 0.001), suggesting that untreated patients were more likely to progress to the advanced stages. Symptoms onset, the time between symptom onset and treatment initiation, age, sex, and disease duration explained 28.95% of the total variation in the MDS-UPDRS-III score for motor symptoms. In drug-naïve patients, the time between symptom onset and treatment initiation explained 20.1% of the total variation in the MDS-UPDRS-III score for motor symptoms (t = 6.15, p < 0.001). Conclusions These data in our study showed that early dopaminergic replacement treatment have played a positive role in PD patients, while dopaminergic replacement delayed treatment might be detrimental to motor symptoms and non-motor state of PD patient. Recognizing early stage symptoms of PD and early diagnosis are of great significance to treatment.
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Affiliation(s)
- Xin Li
- Tianjin Medical University, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Zhao-ying Dong
- Department of Neurology, Tianjin People's Hospital Tianjin Union Medical Center, Tianjin, China
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Meng Dong
- Tianjin Medical University, Tianjin, China
| | - Lei Chen
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Key Laboratory of Cerebrovascular Diseases and Neurodegenerative Disease, Tianjin, China
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Akbar M, Soraya GV, Ulhaq ZS, Bintang AK. A Roadmap for Future Parkinson's Pharmacogenomics in Asia. Front Aging Neurosci 2022; 14:896371. [PMID: 35656536 PMCID: PMC9152086 DOI: 10.3389/fnagi.2022.896371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Muhammad Akbar
- Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- *Correspondence: Muhammad Akbar
| | - Gita Vita Soraya
- Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Zulvikar Syambani Ulhaq
- Research Center for Pre-Clinical and Clinical Medicine, National Research and Innovation Agency Republic of Indonesia, Cibinong, Indonesia
| | - Andi Kurnia Bintang
- Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Sy MAC, Fernandez HH. Pharmacological Treatment of Early Motor Manifestations of Parkinson Disease (PD). Neurotherapeutics 2020; 17:1331-1338. [PMID: 32935299 PMCID: PMC7851218 DOI: 10.1007/s13311-020-00924-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 01/17/2023] Open
Abstract
Parkinson disease (PD), as a slowly progressive neurodegenerative disorder, undergoes six neuropathological stages. The earliest clinical manifestation presents in the middle stage of the disorder pathologically, when 50% or more of the dopaminergic neurons have degenerated in the substantia nigra. This discrepancy between the early stage clinically and that pathologically has, in part, spurred the debate as to when it is best to initiate symptomatic therapy. The most well-studied monotherapeutic agents for PD in its early course include levodopa (the cornerstone of PD therapy), dopamine agonists, and monoamine oxidase inhibitors (MAOIs). With several options for initiating pharmacologic therapy, along with the heterogenous presentation of the disorder, an individualized approach is warranted. Careful deliberation must be done to optimize risk reduction while providing effective symptom control, taking the chronological age, comorbidities, social and financial disposition, work status, and both immediate- and long-term goals into consideration. Generally, treatment can be delayed in patients with mild symptoms and minimal functional impairment at any age. If treatment must be initiated, dopamine agonists and monoamine oxidase type B inhibitors can be used, especially in younger patients with milder disease. However, for older patients, those with moderate to severe PD symptoms, regardless of age, or for patients with greater comorbidities, levodopa generally remains the better choice. Eventually, regardless of initial therapy, studies have shown that most will eventually require levodopa therapy when symptoms become more disabling.
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Affiliation(s)
- Michelle Ann C Sy
- Movement Disorders Section, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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de Bie RMA, Clarke CE, Espay AJ, Fox SH, Lang AE. Initiation of pharmacological therapy in Parkinson's disease: when, why, and how. Lancet Neurol 2020; 19:452-461. [PMID: 32171387 DOI: 10.1016/s1474-4422(20)30036-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/14/2019] [Accepted: 11/20/2019] [Indexed: 12/23/2022]
Abstract
Debate is ongoing regarding when, why, and how to initiate pharmacotherapy for Parkinson's disease. Early initiation of dopaminergic therapies does not convey disease-modifying effects but does reduce disability. Concerns about the development of motor complications arising from the early initiation of levodopa, which led to misconceived levodopa-sparing strategies, have been largely mitigated by the outcomes of the PD MED and Levodopa in Early Parkinson's Disease (LEAP) studies. The LEAP study also showed the potential for early improvement in quality of life, even when disability is negligible. Until more effective methods of providing stable dopamine concentrations are developed, current evidence supports the use of levodopa as initial symptomatic treatment in most patients with Parkinson's disease, starting with low doses and titrating to therapeutic threshold. Monoamine oxidase-B inhibitors and dopamine agonists can be reserved as potential adjunct treatments later in the disease course. Future research will need to establish effective disease-modifying treatments, address whether patients' quality of life is substantially improved with early initiation of treatment rather than a wait and watch strategy, and establish whether new levodopa formulations will delay onset of dyskinesia.
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Affiliation(s)
- Rob M A de Bie
- Amsterdam University Medical Centers, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Carl E Clarke
- Department of Neurology, City Hospital, Sandwell and West Birmingham NHS Trust, Birmingham, UK; Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alberto J Espay
- UC Gardner Neuroscience Institute and James J and Joan A Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Susan H Fox
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Anthony E Lang
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada.
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Dahodwala N, Willis AW, Li P, Doshi JA. Prevalence and Correlates of Anti-Parkinson Drug Use in a Nationally Representative Sample. Mov Disord Clin Pract 2017; 4:335-341. [PMID: 30363446 PMCID: PMC6174430 DOI: 10.1002/mdc3.12422] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 06/16/2016] [Accepted: 06/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although numerous prescription drugs are available to treat Parkinson's disease (PD), little is known about national use in clinical practice and which factors may influence variability in care. The objectives of this study were to describe the prevalence of anti-Parkinson drug use among Medicare beneficiaries with PD and to identify demographic and clinical factors associated with drug use. METHODS This retrospective study was based on a random sample of annual 5% Medicare Part A and B claims linked with Medicare Part D drug files from 2007 through 2010. The study sample included fee-for-service Medicare beneficiaries with continuous stand-alone Part D enrollment who had been diagnosed with PD in the given year. First, any PD drug use and drug use by class (levodopa, dopamine agonist, anticholinerigc, monoamine oxidase B inhibitors, catechol-O-methyltransferase inhibitors, and amantadine) were described. Using generalized estimating equation regressions, patient and provider characteristics associated with anti-Parkinson drug use and choice were examined. RESULTS Over 81% of patients with PD were treated with anti-Parkinson drugs, and this proportion was stable over the 4 years of the study. The majority were treated with levodopa (90%); followed by dopamine agonists (29-31%); then monoamine oxidase B inhibitors, anticholinergics, amantadine, and catechol-O-methyltransferase inhibitors (all between 5% and 11%). Holding all else equal, patients who were not seen by a neurologist (odds ratio, 0.41; 95% confidence interval, 0.38-0.44; P < 0.001) and African-American patients (odds ratio, 0.80; 95% confidence interval, 0.69-0.93; P = 0.003) were significantly less likely to be treated. CONCLUSIONS Among a national sample of Medicare beneficiaries with PD, the majority received anti-Parkinson drugs. However, there was relative under-treatment of African-Americans and patients who were not seen by a neurologist for care.
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Affiliation(s)
- Nabila Dahodwala
- Department of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Allison W. Willis
- Department of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Pengxiang Li
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jalpa A. Doshi
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Motor and non-motor symptoms of Parkinson's disease and their impact on quality of life and on different clinical subgroups. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2014.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease and pathologically is characterised by a progressive loss of dopaminergic cells of the nigrostriatal pathway. Clinically, PD is mainly defined by the presence of the motor symptoms of bradykinesia, rigidity, rest tremor and postural instability, but non-motor symptoms such as depression, dementia and autonomic disturbances are recognised as integral parts of the disease. Although pharmacotherapy for PD was introduced almost 50 years ago, and has improved significantly over the intervening period, the timing of initiation of treatment in newly diagnosed PD remains controversial. While some physicians favour an early start of pharmacotherapy at or soon after diagnosis, others prefer to delay pharmacological treatment until a certain degree of disability has developed. This article aims to discuss the advantages and disadvantages of both strategies by exploring their effects on symptoms, disease progression and quality of life. Although the data on putative disease-modifying effects of early pharmacological intervention in PD are still inconclusive, we believe that the most important indication for an early initiation of anti-parkinsonian treatment should be to maintain the quality of life of PD patients and to secure their socioeconomic status as long as possible.
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Berganzo K, Tijero B, González-Eizaguirre A, Somme J, Lezcano E, Gabilondo I, Fernandez M, Zarranz JJ, Gómez-Esteban JC. Motor and non-motor symptoms of Parkinson's disease and their impact on quality of life and on different clinical subgroups. Neurologia 2014; 31:585-591. [PMID: 25529173 DOI: 10.1016/j.nrl.2014.10.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/10/2014] [Accepted: 10/23/2014] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The aim of the present study is to analyse the influence that motor and non-motor symptoms have on the quality of life (QoL) of patients with Parkinson's disease (PD), and to study the relationship between the two types of symptoms. MATERIAL AND METHODS This cross-sectional study included 103 patients with PD (55 men and 48 women). Quality of life was measured on the PDQ-39 scale. The UPDRS scale (I-IV) was also used, and different items were grouped to analyse the presence of tremor, rigidity, bradykinesia, and axial symptoms. The non-motor symptoms scale (NMSS) was administered to assess non-motor symptoms. We performed correlation analyses between different scales to analyse the influence of motor and non-motor symptoms on QoL. RESULTS Correlations were observed between the PDQ-39 summary index (PDQ39_SI) and the NMSS (correlation coefficient [cc], 0.56; p<.001), UPDRS III (cc, 0.44; p< .001) and UPDRS IV (cc, 0.37; p<.001) scores. The strongest correlation was between cognitive symptoms and mood. The analysis pointed to a direct relationship between the NMSS score and axial symptoms (cc, 0.384; p<.01), bradykinesia (cc, 0.299; p<.01), and to a lesser extent, rigidity (cc, 0.194; p<.05). No relationship was observed between presence of tremor and the NMSS score. CONCLUSION Cognitive symptoms and mood exert the most influence on QoL of patients with PD. We found at least two phenotypes; one with predominantly axial symptoms, with significant involvement of non-motor symptoms, and a tremor-associated phenotype in which these symptoms are less prevalent.
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Affiliation(s)
- K Berganzo
- Grupo Enfermedades Neurodegenerativas, Unidad de trastornos del movimiento y disautonomía, BioCruces Health Research Institute, Barakaldo, Bizkaia, España.
| | - B Tijero
- Grupo Enfermedades Neurodegenerativas, Unidad de trastornos del movimiento y disautonomía, BioCruces Health Research Institute, Barakaldo, Bizkaia, España
| | - A González-Eizaguirre
- Grupo Enfermedades Neurodegenerativas, Unidad de trastornos del movimiento y disautonomía, BioCruces Health Research Institute, Barakaldo, Bizkaia, España
| | - J Somme
- Servicio de Neurología, Hospital Universitario Álava, Vitoria-Gasteiz, España
| | - E Lezcano
- Grupo Enfermedades Neurodegenerativas, Unidad de trastornos del movimiento y disautonomía, BioCruces Health Research Institute, Barakaldo, Bizkaia, España
| | - I Gabilondo
- Grupo Enfermedades Neurodegenerativas, Unidad de trastornos del movimiento y disautonomía, BioCruces Health Research Institute, Barakaldo, Bizkaia, España
| | - M Fernandez
- Grupo Enfermedades Neurodegenerativas, Unidad de trastornos del movimiento y disautonomía, BioCruces Health Research Institute, Barakaldo, Bizkaia, España
| | - J J Zarranz
- Grupo Enfermedades Neurodegenerativas, Unidad de trastornos del movimiento y disautonomía, BioCruces Health Research Institute, Barakaldo, Bizkaia, España
| | - J C Gómez-Esteban
- Grupo Enfermedades Neurodegenerativas, Unidad de trastornos del movimiento y disautonomía, BioCruces Health Research Institute, Barakaldo, Bizkaia, España
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Duncan GW, Khoo TK, Yarnall AJ, O'Brien JT, Coleman SY, Brooks DJ, Barker RA, Burn DJ. Health-related quality of life in early Parkinson's disease: The impact of nonmotor symptoms. Mov Disord 2013; 29:195-202. [DOI: 10.1002/mds.25664] [Citation(s) in RCA: 250] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/18/2013] [Accepted: 08/12/2013] [Indexed: 12/20/2022] Open
Affiliation(s)
- Gordon W. Duncan
- Institute for Ageing and Health, Newcastle University; Newcastle UK
| | - Tien K. Khoo
- School of Medicine; Griffith University; Queensland Australia
| | | | - John T. O'Brien
- Department of Psychiatry; University of Cambridge; Cambridge UK
| | | | | | - Roger A. Barker
- Cambridge Centre for Brain Repair; Cambridge University; Cambridge UK
| | - David J. Burn
- Institute for Ageing and Health, Newcastle University; Newcastle UK
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Tveiten OV, Skeie GO, Haugarvoll K, Müller B, Larsen JP, Tysnes OB. Treatment in early Parkinson's disease: the Norwegian ParkWest study. Acta Neurol Scand 2013. [PMID: 23190324 DOI: 10.1111/ane.12055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There are limited data on treatment effect in early and drug-naïve Parkinson's disease (PD) outside of clinical trials. We sought to review the treatment effects on motor symptoms in early, unselected PD patients. METHODS We included 183 drug-naïve patients from a longitudinal cohort (The Norwegian ParkWest study). At the time of diagnosis, motor symptoms were assessed and rated. Treatment was unrestricted, aimed at treating each patient optimally. Patients were reassessed after 12 months, and then grouped according to treatment: No dopaminergic treatment (NDT), dopamine agonists (DA) or levodopa. All strategies could be combined with monoamine oxidase B inhibitors. RESULTS In general, the chosen treatment was coherent with current practice. During follow-up, patients given NDT (n = 40) had unaltered clinical motor symptoms, as opposed to improvement in the DA- and levodopa-treated patients (n = 140). The overall improvement in these two groups was fairly similar, but axial symptoms did not improve in levodopa-treated patients as opposed to the younger DA-treated patients. CONCLUSIONS Twelve months after the diagnosis, motor symptoms in approximately one-fifth of PD patients remained clinically stable. Tremor, bradykinesia and rigidity improved in the dopaminergic-treated patients. Axial symptoms were more treatment resistant, and the different symptomatic effects found between treatment strategies may be age related.
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Affiliation(s)
- O. V. Tveiten
- Department of Neurology; Haukeland University Hospital; Bergen; Norway
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Clarke CE, Patel S, Ives N, Rick C, Wheatley K, Gray R. Should treatment for Parkinson's disease start immediately on diagnosis or delayed until functional disability develops? Mov Disord 2011; 26:1187-93. [DOI: 10.1002/mds.23519] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 08/20/2010] [Accepted: 10/13/2010] [Indexed: 12/14/2022] Open
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Cubo E. Pharmacotherapy in the management of early Parkinson's disease: cost-effectiveness and patient acceptability. CLINICOECONOMICS AND OUTCOMES RESEARCH 2010; 2:127-34. [PMID: 21935322 PMCID: PMC3169957 DOI: 10.2147/ceor.s11996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Indexed: 11/23/2022] Open
Abstract
In the absence of a cure, the primary goals in managing Parkinson's disease (PD) are to preserve functionality and health-related quality of life (HRQoL). Current therapeutic strategies for PD include symptomatic treatment and are primarily focused on replacing dopamine in the brain. Dopamine agonists can be used as an alternative initial levodopa therapy, to delay the onset of motor complications, but at the expense of more dopaminergic adverse effects; poorer control of motor symptoms; and increased cost. In PD, treatment effects and costs accumulate over time; hence the choice of time horizon in cost-effectiveness analysis can be particularly important. Pharmaceutical expenditures have grown rapidly in recent decades and now total nearly 10% of all health care costs. The main approach to treat PD at the present time is to advance knowledge of the efficacy, to reduce long-term complications associated with treatment, and to improve patient HRQoL and society burden. The implementation of cost-effectiveness studies, including the societal perspective, should be considered as an outcome of new therapy strategies, which would be helpful to health care decision makers.
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Affiliation(s)
- Esther Cubo
- Neurology Department, Hospital General Yagüe, Burgos, Spain
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Abstract
Parkinson's disease (PD) is one of the most common chronic neurodegenerative diseases. Levodopa provides the best symptomatic benefit with the fewest short-term adverse effects, but its use is associated with the development of motor fluctuations and dyskinesias. The introduction of dopamine agonists early in the treatment of PD leads to a delay of these motor complications, but all available dopamine agonists may cause profound adverse effects in some patients. The objective of this manuscript is to review the initial treatment, the neurotoxicity of levodopa, the swallowing disturbance and QOL of PD. Levodopa still is the gold standard for PD. However, the treatment decisions should be based on considerations of risks versus benefits for individual patients.
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Ford MP, Malone LA, Nyikos I, Yelisetty R, Bickel CS. Gait training with progressive external auditory cueing in persons with Parkinson's disease. Arch Phys Med Rehabil 2010; 91:1255-61. [PMID: 20684907 DOI: 10.1016/j.apmr.2010.04.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/19/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the progressively increasing external auditory cues during mobility training with persons with Parkinson's disease (PD). DESIGN Experimental. SETTING General community. PARTICIPANTS Convenience sample of persons with PD (N=12) who walked independently. INTERVENTIONS Gait training to external auditory cues was based on a participant's comfortable walking pace. Training external auditory cues rates were increased if patients were able to maintain or increase stride length with increasing external auditory cues rate. Movement synchronization was not monitored during training. Participants trained for 30min/session, 3 sessions/wk, for 8 weeks. MAIN OUTCOME MEASURES Walking velocity, stride length, and cadence. RESULTS Participants trained at a mean maximal rate of 157bpm. They showed a significant (P<.01) increase in walking velocity, stride length, and cadence after 8 weeks of training. CONCLUSIONS Walking velocity, stride length, and cadence can significantly improve when community-dwelling persons with PD participate in progressive mobility training.
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Affiliation(s)
- Matthew P Ford
- Department of Physical Therapy, University of Alabama, Birmingham, Birmingham, AL, USA.
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Maetzler W, Liepelt I, Berg D. Progression of Parkinson's disease in the clinical phase: potential markers. Lancet Neurol 2009; 8:1158-71. [PMID: 19909914 DOI: 10.1016/s1474-4422(09)70291-1] [Citation(s) in RCA: 204] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Neuromodulatory or even neuroprotective therapy could soon be available for Parkinson's disease (PD), raising the question of how we should define and measure disease progression. Reported evidence suggests that several symptoms worsen with disease duration. Bradykinesia, rigidity, and activities of daily living deteriorate faster at the beginning of the disease, and this deterioration is paralleled by a decline in functional presynaptic dopaminergic activity, as shown by imaging techniques. Cognitive, speech, sleep, and gait difficulties might progress linearly in proportion to disease duration. Reduced variability in heart rate, orthostatic dysfunction, and visual hallucinations start to develop at mid-stage disease and are more common in late stages than earlier stages. In this Review, we summarise our current understanding of the progression of PD-associated symptoms and markers and conclude that an effective measurement of progression of PD must adapt to the different stages of the disease. In addition to routine clinical rating scales, new quantitative assessments of motor and non-motor symptoms, which should be more broadly available, reasonably priced, and easy-to-use, are needed.
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Affiliation(s)
- Walter Maetzler
- Center of Neurology, Department of Neurodegeneration and Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
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Dahodwala N, Xie M, Noll E, Siderowf A, Mandell DS. Treatment disparities in Parkinson's disease. Ann Neurol 2009; 66:142-5. [PMID: 19743462 DOI: 10.1002/ana.21774] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We sought to identify racial disparities in the treatment of Parkinson's disease (PD). We identified 307 incident PD cases using Pennsylvania State Medicaid claims, and extracted claims for medications, physical therapy, and healthcare visits for the 6 months after diagnosis. After controlling for age, sex, and geography, African-Americans were four times less likely than whites to receive any PD treatment (odds ratio, 0.24; 95% confidence interval, 0.09-0.64), especially indicated medications. In a group with the same healthcare insurance, disparities in PD treatment exist. Physician and community awareness of these racial differences in PD treatment is the first step in addressing healthcare disparities.
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Affiliation(s)
- Nabila Dahodwala
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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