Efficacy of Pramipexole for Treatment of Apathy in Parkinson’s Disease

Hiroaki Oguro,Masaki Ishihara,Shuhei Yamaguchi,Kazunori Okada,Katsuhiko Kadota

doi:10.4236/ijcm.2014.515118

Hiroaki Oguro, Masaki Ishihara + Show 3 more

Open Access

https://doi.org/10.4236/ijcm.2014.515118

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Abstract

Background: Apathy occurs frequently in patients with Parkinson’s disease (PD), and has a negative impact on activities of daily living through loss of motivation. Pramipexole (PPX), which shows preferential affinity for D3 dopamine receptor in the mesolimbic system, is thought to influence mood and motivation. Therefore, we conducted an open-label case-control study to examine the effect of PPX on apathy in PD. Methods: We studied 36 PD patients (mean age, 70.4 ± 8.1 years), who had been treated only with L-DOPA. PPX was added to L-DOPA treatment in 24 patients (PPX group) and other 12 patients continued with L-DOPA alone (non-PPX group). The study period was 8 weeks. Apathy was assessed using the revised apathy scale for Japanese. Motor function was assessed with part III of the Unified Parkinson’s Disease Rating Scale (UPDRS). Results: Seventeen of 36 patients (47%) were diagnosed as having apathy. In the PPX group, apathy scale significantly improved from 17.3 to 13.8 at week 8 (p

Highlights

Parkinson’s disease (PD) is caused by progressive degeneration of dopamine-producing cells in the substantia nigra, and has been treated with L-dopa and dopamine receptor agonist
To examine which clinical factors contribute to the effects of PPX, we assessed the effects of age, gender, length of illness, Unified Parkinson’s Disease Rating Scale (UPDRS) score, Mini-mental state examination (MMSE) and daily dose of L-DOPA by means of logistic regression analysis
Before PPX treatment, 14 of 24 (58%) patients in the PPX group were diagnosed as having apathy

Summary

Introduction

Parkinson’s disease (PD) is caused by progressive degeneration of dopamine-producing cells in the substantia nigra, and has been treated with L-dopa and dopamine receptor agonist. Pramipexole (PPX) has dopamine agonist activity at presynaptic and postsynaptic dopamine receptors belonging to the D2-like family and is effective in treating Parkinson’s disease, showing high affinity for dopamine D3 receptor [1]. Apathy has a negative impact on activities of daily living owing to loss of motivation, concern, interest and emotional response [2] It has been associated with executive dysfunction, impaired emotional processing and impaired decision-making, and it causes flattened affect and decrease of goal-directed behavior [3]. It can be a substantial burden for caregivers and may occur as a part of the symptoms of depression or dementia [2]. We studied the clinical efficacy of PPX on apathy in PD using the self-assessed apathy scale

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Results

Discussion