Medication Side Effect Profiles in PD Patients in a Safety-Net Hospital

Abstract

Background: Compulsive behavior, dyskinesias, motor fluctuations, and hallucinations are common Parkinson’s disease (PD) medication side effects. These are yet to be examined in relation to race and level of education. The goal of this analysis was to identify socioeconomic or clinical variables that are associated with compulsive behavior, dyskinesias, motor fluctuations, and hallucinations in patients in a safety-net hospital. Methods: A movement disorder patient database containing 452 patients with idiopathic PD was analyzed for differences in PD medication side effects using univariate and multivariate logistic regression analysis. Race, sex, and level of education were evaluated as possible confounders. Results: A greater proportion of the patients in this study were Caucasian males. The only variable associated with compulsive behavior was age, with higher age having a protective effect (p = 0.0336). Disease duration (defined as time since the onset of symptoms), diagnosis duration (time since formal diagnosis), and level of education were significantly associated with dyskinesia inunivariate analysis (p =< 0.0001, <0.0001, 0.1236 respectively). However, diagnosis duration was the only variable significantly associated with dyskinesia in multivariate analysis (p = 0.0038), in addition to a borderline significant association when comparing individuals with graduate degree to those who had completed high school education or less (p = 0.0599), with a protective effect of higher education. Disease duration, diagnosis duration, and use of monoamineoxidase inhibitors were also significantly associated with motor fluctuations in the univariate analysis, while only diagnosis duration was significantly associated with motor fluctuations in multivariate analysis (p = 0.0035) with longer diagnosis duration associated with higher risk of motor fluctuations. Age, disease duration, and diagnosis duration were associated with an increased risk of hallucinations in univariate analysis (p =< 0.0001, <0.0001, <0.0001 respectively), but age and disease duration were the only variables associated with hallucinations in multivariate analysis (p = 0.0009, 0.1196 respectively). Race was not associated with a higher risk of compulsive behavior, dyskinesias, motor fluctuations, or hallucinations. Conclusion: Compulsive behavior, dyskinesias, motor fluctuations, and hallucinations in our PD population may be associated with differences in socioeconomic status and access to care, but not with differences in race.