TY - JOUR

T1 - Improvement by Medication Less than Expected in Parkinson's Disease

T2 - Blinded Evaluation of Levodopa Response

AU - Johansen, Mette Niemann

AU - Handberg, Anna

AU - El Haddouchi, Mohamed

AU - Grundtvig, Josefine

AU - Jensen, Steen Rusborg

AU - Salvesen, Lisette

AU - Løkkegaard, Annemette

N1 - Copyright © 2024 Mette Niemann Johansen et al.

PY - 2024

Y1 - 2024

N2 - BACKGROUND: The latest Movement Disorder Society (MDS) diagnostic criteria require a good and sustained response to medication to get a diagnosis of Parkinson's disease, PD.OBJECTIVE: The aim of this study was to evaluate levodopa response in a group of patients with probable PD, diagnosed by movement disorder specialists.METHODS: An acute levodopa challenge test (LDCT) was performed after pausing the dopaminergic medication for 6 half-times. The motor part of the Unified Parkinson's Disease Rating Scale was performed in the OFF-state and after LDCT (ON). A good effect was defined as >30% improvement. A video-protocol was used to secure standardized motor examination with blinded assessments of the UPDRS-III OFF and ON. An age-matched group of control subjects (CS) was included but did not go through LDCT. All participants were evaluated with Montreal Cognitive Assessment (MoCA) and Beck's Depression Inventory (BDI).RESULTS: In the statistical analysis, 37 patients were included. Twenty-one patients showed an improvement ≤30%, while 16 patients showed an improvement >30%. LDCT showed an overall mean improvement of 27.3% of motor UPDRS. In 43.2%, there was a discrepancy between the effect seen with the LDCT and the patients' self-perceived medicine evaluation. Patients with PD had a significantly lower MoCA score and more depressive symptoms compared to CS.CONCLUSIONS: We showed an acute effect of levodopa using LDCT that was around 30% improvement. While it lends support to the use of this limit in the MDS diagnostic criteria, an acute effect of less than 30% should be considered acceptable in some patients. Our study highlights a discrepancy in the objective measure of medicine effect on motor symptoms and the patient's subjective evaluation.

AB - BACKGROUND: The latest Movement Disorder Society (MDS) diagnostic criteria require a good and sustained response to medication to get a diagnosis of Parkinson's disease, PD.OBJECTIVE: The aim of this study was to evaluate levodopa response in a group of patients with probable PD, diagnosed by movement disorder specialists.METHODS: An acute levodopa challenge test (LDCT) was performed after pausing the dopaminergic medication for 6 half-times. The motor part of the Unified Parkinson's Disease Rating Scale was performed in the OFF-state and after LDCT (ON). A good effect was defined as >30% improvement. A video-protocol was used to secure standardized motor examination with blinded assessments of the UPDRS-III OFF and ON. An age-matched group of control subjects (CS) was included but did not go through LDCT. All participants were evaluated with Montreal Cognitive Assessment (MoCA) and Beck's Depression Inventory (BDI).RESULTS: In the statistical analysis, 37 patients were included. Twenty-one patients showed an improvement ≤30%, while 16 patients showed an improvement >30%. LDCT showed an overall mean improvement of 27.3% of motor UPDRS. In 43.2%, there was a discrepancy between the effect seen with the LDCT and the patients' self-perceived medicine evaluation. Patients with PD had a significantly lower MoCA score and more depressive symptoms compared to CS.CONCLUSIONS: We showed an acute effect of levodopa using LDCT that was around 30% improvement. While it lends support to the use of this limit in the MDS diagnostic criteria, an acute effect of less than 30% should be considered acceptable in some patients. Our study highlights a discrepancy in the objective measure of medicine effect on motor symptoms and the patient's subjective evaluation.

U2 - 10.1155/2024/2649578

DO - 10.1155/2024/2649578

M3 - Journal article

C2 - 38419645

VL - 2024

JO - Parkinson's Disease

JF - Parkinson's Disease

SN - 2042-0080

M1 - 2649578

ER -