Abstract
Background Individuals with Parkinson's Disease (PD) have bradykinesia during mobility tasks in the morning before intake of dopaminergic treatment and have difficulties managing Activities of Daily Living (ADLs). Early morning off (EMO) refers to off-states in the morning where the severity of bradykinesia is increased and causes a decrease in mobility related to wearing off of effects of medication. Measurements from devices capable of continuously recording motor symptoms may provide insight into the patient's response to medication and possible impact on ADLs. Objectives To test whether poor or slow response to medication in the morning predicts the overall ADL-level and to assess the association between change in bradykinesia score (BKS) and the risk of having disabilities within three selected ADL-items. Methods In this cross-sectional study, the sample consists of 34 patients with light to moderate PD. Data collection encompasses measurements from the Parkinson KinetiGraph, and the ADL-limitations are assessed by the Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part II. Results The association between UPDRS- II and BKS from the algorithm was −0.082 (p < 0.01), 95% CL:−0.113; −0.042). The individuals experienced disabilities in performing “Speech” (p=0.004) and “Doing hobbies” (p=0.038) when being slow or poor responders to dopaminergic therapy. The PD patients' L-dopa equivalent dose seems to be a strong predictor of the ADL-level in the morning. Conclusion Slow response to the medication dosages in the morning is correlated with disabilities in the overall ADL-level in PD. The combination of PD-drugs and precise, timely dosages must be considered in the improvement of the ADL-level in PD patients.
Highlights
Parkinson’s Disease (PD) is a progressive, neurodegenerative disease
PD patients are challenged by nonmotor symptoms as cognitive and autonomic symptoms as well as neuropsychiatric difficulties [1]. us, living with PD influences the physical, mental, and social health of patients, and there is an increasing need to understand the impact of PD symptomatology on the ability to perform activities of daily living (ADL) to be able to provide individualized targeted treatment
OR in “walking and balance” was insignificant, indicating that a poor/slow change in bradykinesia score (BKS) is not associated with disabilities within this item. This is the first study that examines the relationship between response to medication in the morning and the ADL-level for individuals with PD in a prospective design. ere is a significant correlation between slow response to medication in the morning and the overall ADLlimitations, which is important knowledge in a clinical perspective, though the participants may have underrated their disabilities, as self-assessed underrating of disability is associated with earlier stages of PD, living with family, and high cognitive ability [32], which characterize our cohort
Summary
Parkinson’s Disease (PD) is a progressive, neurodegenerative disease. Patients with PD exhibit heterogeneous clinical phenotypes, and there are a large variability in the symptoms [1] and, courses of disease. Patients with PD are challenged by the classical triad of motor symptoms, Bradykinesia, rigidity, and tremor, and in moderate to severe stage, impairment in gait and balance [2]. Individuals with Parkinson’s Disease (PD) have bradykinesia during mobility tasks in the morning before intake of dopaminergic treatment and have difficulties managing Activities of Daily Living (ADLs). Measurements from devices capable of continuously recording motor symptoms may provide insight into the patient’s response to medication and possible impact on ADLs. Objectives. To test whether poor or slow response to medication in the morning predicts the overall ADL-level and to assess the association between change in bradykinesia score (BKS) and the risk of having disabilities within three selected ADL-items. Results. e association between UPDRS- II and BKS from the algorithm was −0.082 (p < 0.01), 95% CL:−0.113; −0.042)
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