QoL worsens with levodopa-induced complications in PD
Levodopa-induced complications can lead to significant worsening of quality of life (QoL) in Asian patients with Parkinson’s disease (PD), necessitating that clinicians monitor their patients closely and promptly manage such complications, according to a longitudinal local study.
The observational, short-term longitudinal study involved 78 patients (mean age 67.3 years, 66.7 percent, 93.6 percent Chinese) with PD from Singapore General Hospital. They were assessed on levodopa-induced complications using the Unified Parkinson’s Disease Rating Scale part IV (UPDRS IV) and on patient-reported QoL using the 39-item Parkinson’s Disease Questionnaire (PDQ-39) at baseline and 1-year follow-up. [Sci Rep 2019;9:9248]
Among the levodopa-induced complications reported, dyskinesia was the least frequent (13.5 percent) while fluctuations in off symptoms were the most common complication (55.9 percent) at baseline.
At 1 year, there was a trend towards worsening of dyskinesia complications in terms of duration and severity compared with baseline. More patients spent increasing proportion of their waking time having dyskinesia, and this was observed across all quartiles of dyskinesia duration: the proportion of patients having dyskinesia ≤25 percent of their waking day increased from 5.1 percent at baseline to 16.7 percent at 1 year, from 1.3 percent to 2.6 percent for those with dyskinesia 26–50 percent of their waking day, and from 1.3 percent to 2.3 percent for those with dyskinesia 51–75 percent of their waking day.
More patients also reported having more disabling dyskinesia at 1 year than baseline, with increases from 5.1 percent to 9.0 percent for mildly disabling dyskinesia and from 1.3 percent to 2.6 percent for moderately disabling symptom.
In addition, their off periods became longer, more sudden and unpredictable at 1 year, as indicated on the UPDRS IV.
Following worsening of levodopa-induced complications at follow-up, patient-reported QoL also worsened significantly, as indicated by the summary index (SI) score of PDQ-39. In particular, declines in the domains of activities of daily living (p=0.000), emotional well-being (p=0.005), cognition (p=0.001), and communication (p=0.015) were observed.
“Therefore, when addressing patients’ complaints, clinicians may prioritize addressing treatment complications related to these domains,” pointed out the researchers led by Dr Prakash Kumar of Duke‐NUS Medical School, Singapore.
Furthermore, the researchers found an association between change in UPDRS IV total score PDQ-SI (p=0.014), supporting the notion that worsening of levodopa-induced complications was predictive of QoL.
“Other lesser predictive factors included female gender, NMSS* total score and UPDRS III total score,” said Kumar and co-authors. “The findings suggest that patients with these factors may be anticipated to have worsening of QoL over time if their symptoms are not managed appropriately.”
“This substantiates the importance for clinicians to closely monitor and promptly manage the levodopa therapy-induced complications that may arise in PD patients,” they added.
Nonetheless, they also acknowledged that the homogenous population with mostly mild to moderate stages of PD (Hoehn and Yahr scale stage <3) may limit the generalizability of the findings to those with more severe motor complications in more advanced disease stages.
“This is an on-going study and patients are still continuously being assessed and followed up,” the researchers said.
“Further studies that involve developing strategies for effective management, delaying the onset, or even possibly preventing these complications will be valuable to explore,” they suggested.