Abstract
Objectives Adherence to medication is an important factor that can influence Parkinson's disease (PD) control. We aimed to explore patients' adherence to antiparkinsonian medication and determine factors that might affect adherence to medications among PD patients. Methods A cross-sectional, exploratory survey of PD patients treated with at least one antiparkinsonian drug and with a total score of MoCA (Montreal Cognitive Assessment) ≥26 was conducted. The final sample included 112 PD patients. A patient's adherence was assessed through ARMS (Adherence to Refills and Medications Scale). ARMS scores higher than 12 were assumed lower adherence. In addition, each patient underwent neurological examination, assessment of depression, anxiety, and evaluation of the presence of PD nonmotor symptoms. Results The mean ARDS value in our cohort was 14.9 ± 2.5. Most PD patients (74.1%) reported lower adherence to their medication. Participants in the lower adherence group were younger at PD onset, had significantly higher UPDRS (Unified PD Rating Scale) scores, as well as UPDRS III and UPDRS IV subscores, HARS (Hamilton Anxiety Rating Scale), and NMSQuest (Non-Motor Symptoms Questionnaire for PD) scores compared to the fully adherent group (p=0.013, p=0.017, p=0.041, p=0.043, and p=0.023, respectively). Among nonmotor PD symptoms, the presence of cardiovascular, apathy/attention-deficit/memory disorders, hallucinations/delusions, and problems regarding changes in weight, diplopia, or sweating were associated with lower adherence. Multivariate regression analysis revealed depression as the strongest independent predictor of lower adherence. Conclusion Depressed PD patients compared to PD patients without clinical depression had a three times higher risk for lower adherence to pharmacotherapy. Recognition and adequate treatment of depression might result in improved adherence.
Highlights
Pharmacological management of Parkinson’s disease (PD) is multifaceted, and this complexity may negatively impact patients’ adherence to therapy [1]
74.1% of patients reported lower adherence to their medication schedule (ARMS scores of >12). Compared with those who reported “perfect” adherence, participants with lower adherence had more severe disease, poorer motor status, more therapy-related complications such as motor fluctuations and hallucinations, poorer daily functioning, higher anxiety scores, and more nonmotor symptoms. e strongest predictor of lower adherence was depression, which increases the risk of lower adherence 3.4 times
Different studies have used various tools to evaluate and assess PD patients’ adherence to medication, including selfreports, pill count, physician judgment, medication possession ratio based on pharmacy refill data, and electronic monitoring caps on all antiparkinsonian drugs [18, 19]
Summary
Pharmacological management of PD is multifaceted, and this complexity may negatively impact patients’ adherence to therapy [1]. Suboptimal adherence in PD is associated with poor control of symptoms, poor outcomes, and higher overall healthcare costs as well as with unnecessary therapy adjustments, such as increasing the doses or introduction of additional drugs [4]. It can produce diagnostic uncertainty and point clinicians to an erroneous conclusion about atypical Parkinsonism conditions [7]. E Adherence to Refills and Medications Scale (ARMS-12) was used to assess adherence to medication in PD patients [17] It consists of 12 items, the first eight of which concern the act of taking medications as prescribed, and the other four—the act of filling new prescriptions or refilling prescriptions on time. Testing was performed during the “on” phase (the phase in which the optimal drug therapy and motor improvement were achieved in the patient)
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