Abstract
Background: Nonadherence to medication is a common and serious issue in the treatment of patients with Parkinson's disease (PD). Among others, distinct nonmotor symptoms (NMS) were found to be associated with nonadherence in PD. Here, we aimed to confirm the association between NMS and adherence.Methods: In this observational study, the following data were collected: sociodemographic data, the German versions of the Movement Disorder Society-sponsored revision of the unified Parkinson's disease rating scale for motor function (MDS-UPDRS III), Hoehn and Yahr (H&Y) stage, levodopa equivalent daily dose (LEDD), Becks depression inventory II (BDI-II), nonmotor symptoms questionnaire (NMSQ), and the Stendal adherence to medication score (SAMS).Results: The final sample included 137 people with PD [54 (39.4%) females] with a mean age of 71.3 ± 8.2 years. According to SAMS, 10.9% of the patients were fully adherent, 73% were moderately nonadherent, and 16.1% showed clinically significant nonadherence. Nonadherence was associated with LEDD, BDI-II, education level, MDS-UPDRS III, and the NMSQ. The number of NMS was higher in nonadherent patients than in adherent patients. In the multiple stepwise regression analysis, the items 5 (constipation), 17 (anxiety), and 21 (falls) predicted nonadherence to medication. These NMSQ items also remained significant predictors for SAMS after correction for LEDD, MDS-UPDRS III, BDI-II, age, education level, gender, and disease duration.Conclusion: Our study, in principle, confirms the association between NMS burden and nonadherence in PD. However, in contrast to other clinical factors, the relevance of NMSQ in terms of nonadherence is low. More studies with larger sample sizes are necessary to explore the impact of distinct NMS on adherence.
Highlights
Parkinson’s disease (PD) is a common neurodegenerative disorder predicted to increase in prevalence as the population ages [1]
Inclusion criteria include PD diagnosis according to Movement Disorder Society (MDS) diagnosis criteria, which was made by a movement disorder specialist (TP), while exclusion criteria include cerebrovascular disorders, delirium, unable to complete a questionnaire, and PD dementia [Montreal cognitive assessment (MoCA)
In the multiple linear regression analysis, Stendal adherence to medication score (SAMS) was associated with levodopa equivalent daily dose (LEDD), Becks depression inventory (BDI)-II, education level, MDS-UPDRS III, and nonmotor symptoms questionnaire (NMSQ)
Summary
Parkinson’s disease (PD) is a common neurodegenerative disorder predicted to increase in prevalence as the population ages [1]. A plethora of nonmotor symptoms (NMS) can occur and contribute to clinical heterogeneity. These NMS, such as neurobehavioral disorders, cognitive impairment, gastrointestinal dysfunction, bladder dysfunction, or sexual dysfunction, are, by all accounts, very common in individuals with PD and contribute to poor quality of life (QoL) [2]. Adherence scores [eight-item Morisky medication adherence scale (MMAS-8)] positively correlated with disease duration, health-related QoL, depression, frequency, and severity of NMS [NMS scale (NMSS)], and motor and nonmotor complications. In their linear regression, only NMSS scale predicted MMAS-8. We aimed to confirm the association between NMS and adherence
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