The patient's perspective: The effect of levodopa on Parkinson symptoms
| Autor: | Michiel F. Dirkx, Rick C. Helmich, Bastiaan R. Bloem, Jaco W. Pasman, Heidemarie Zach |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male 0301 basic medicine Medication effects medicine.medical_specialty Levodopa Parkinson's disease Visual analogue scale Other Research Donders Center for Medical Neuroscience [Radboudumc 0] Motor symptoms Antiparkinson Agents 03 medical and health sciences 0302 clinical medicine Accelerometry Tremor medicine Humans Resting tremor Aged Aged 80 and over Physician-Patient Relations Dopaminergic Symptom severity Parkinson Disease Middle Aged medicine.disease Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] nervous system diseases Treatment Outcome 030104 developmental biology Neurology Patient Satisfaction Physical therapy Female Neurology (clinical) Geriatrics and Gerontology Psychology 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Parkinsonism & Related Disorders, 35, pp. 48-54 Parkinsonism & Related Disorders, 35, 48-54 |
| ISSN: | 1353-8020 |
| Popis: | Item does not contain fulltext BACKGROUND: Dopaminergic medication adjustments in Parkinson's disease are often solely based on patient reports. However, it is unclear how well patient-based ratings of the levodopa response correlate with clinician-based ratings, and whether this correlation differs between motor symptoms. Here we compare patient-clinician agreement for the effect of levodopa on resting tremor and bradykinesia/rigidity. Furthermore, given patients' reports that tremor is most troublesome during stress, we test for differences in patient-clinician agreement between tremor at rest and stress-induced tremor. METHODS: We included 42 tremulous Parkinson patients, who were clinically rated (using the MDS-UPDRS) in a practically defined OFF-state and after levodopa-benserazide 200/50 mg. Using accelerometry, we quantified the effect of dopaminergic medication and behavioral context (rest vs. cognitive stress) on tremor intensity. Patients rated medication effects on tremor and bradykinesia/rigidity using visual analogue scales. RESULTS: There was only moderate patient-clinician agreement for the effect of levodopa on bradykinesia/rigidity (R2 = 0.18; p < 0.01), and a tendency towards larger agreement for tremor (R2 = 0.44; p < 0.001; difference between correlation coefficients: z = 1.64; p = 0.051). Patient ratings of tremor changes correlated significantly better with accelerometry for tremor during cognitive stress (R2 = 0.35; p < 0.001) vs. tremor at rest (R2 = 0.12; p < 0.05; difference: z = -2.35, p < 0.01). CONCLUSION: The moderate correlations between patient ratings and clinical/accelerometry changes indicate the need for methods to better monitor symptom severity and impairments in daily life, for example wearable sensors. Our findings also suggest that context matters: Parkinson patients' subjective experience of levodopa effectiveness on tremor was largely based on the ability of levodopa to reduce tremor during cognitive stress. |
| Databáze: | OpenAIRE |
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