Abstract
Objective 5- (5 times oral levodopa tablet taken/day) 2- (2 hours of OFF time/day) 1- (1 hour/day of troublesome dyskinesia) criteria have been proposed by a Delphi expert consensus panel for diagnosing advanced Parkinson's disease (PD). The aim of the present study is to compare quality of life (QoL) in PD patients with “5-2-1 positive criteria” vs QoL in PD patients without “5-2-1 positive criteria” (defined as meeting ≥1 of the criteria). Methods This is a cross-sectional, observational, monocenter study. Three different instruments were used to assess QoL: the 39-Item Parkinson's Disease Quality of Life Questionnaire Summary Index Score (PDQ-39SI); a subjective rating of perceived QoL (PQ-10); and the EUROHIS-QOL 8-Item Index (EUROHIS-QOL8). Results From a cohort of 102 PD patients (65.4 ± 8.2 years old, 53.9% males; disease duration 4.7 ± 4.5 years), 20 (19.6%) presented positive 5-2-1 criteria: 6.9% for 5, 17.6% for 2, and 4.9% for 1. 37.5% (12/32) and 25% (5/20) of patients with motor complications and dyskinesia, respectively, presented 5-2-1 negative criteria. Both health-related (PDQ-39SI, 25.6 ± 14 vs 12.1 ± 9.2; p < 0.0001) and global QoL (PQ-10, 6.1 ± 2 vs 7.1 ± 1.3; p=0.007; EUROHIS-QOL8, 3.5 ± 0.5 vs 3.7 ± 0.4; p=0.034) were worse in patients with 5-2-1 positive criteria. Moreover, nonmotor symptoms burden (Non-Motor Symptoms Scale total score, 64.8 ± 44.8 vs 39.4 ± 35.1; p < 0.0001) and autonomy for activities of daily living (ADLS scale, 73.5 ± 13.1 vs 89.2 ± 9.3; p < 0.0001) were worse in patients with 5-2-1 positive criteria. Patient's principal caregiver's strain (Caregiver Stain Index, 4.3 ± 3 vs 1.5 ± 1.6; p < 0.0001), burden (Zarit Caregiver Burden Inventory, 28.4 ± 12.5 vs 10.9 ± 9.8; p < 0.0001), and mood (Beck Depression Inventory II, 12.2 ± 7.2 vs 6.2 ± 6.1; p < 0.0001) were worse in patients with 5-2-1 positive criteria as well. Conclusions QoL is worse in patients meeting ≥1 of the 5-2-1 criteria. This group of patients and their caregivers are more affected as a whole. These criteria could be useful for identifying patients in which it is necessary to optimize Parkinson's treatment.
Highlights
In Parkinson’s disease (PD), effective management is key at all stages and often requires individual customization of therapy as the disease progresses [1]
In the absence of a biomarker, a diagnostic test, or a gold standard index to determine the severity of PD, clinicians often rely on varied clinical evaluation and medical history to determine staging in PD [2]
Motor fluctuations are related to a greater nonmotor symptoms (NMS) burden, a worse quality of life (QoL), and less functional independence for activities of daily living [11, 12]
Summary
In Parkinson’s disease (PD), effective management is key at all stages and often requires individual customization of therapy as the disease progresses [1]. Parkinson’s Disease the adjustment of symptomatic treatment will improve the patients’ quality of life and autonomy In this context, 5- (5 times oral levodopa tablet taken/ day) 2- (2 hours of OFF time/day) 1 (1 hour/day of troublesome dyskinesia) criteria have recently been proposed by a Delphi expert consensus panel for diagnosing advanced PD [8, 13]. Nonmotor symptoms (NMS) burden, patients’ QoL, and the patient’s principal caregiver status was compared between both groups to determine if 5-2-1 criteria could be a useful screening tool for identifying advanced PD patients who need an optimization of Parkinson’s treatment
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