Abstract
Introduction: The impact of levodopa-induced dyskinesia (LID) on the daily lives of patients with Parkinson's disease (PD) remains to be determined. Furthermore, evidence suggests that cardinal motor symptoms of PD may coexist with LID, but their impact on activities of daily living (ADL) relative to LID is not known. This cross-sectional study aimed at determining the effect of LID and cardinal motor symptoms of PD on ADL in patients who were experiencing peak-dose choreic-type LID.Method: One hundred and twenty-one patients diagnosed with PD known to experience choreic-type LID were recruited for the study. Patients were asked to perform a set of ADL. Levels of LID, tremor, bradykinesia, and freezing of gait (FoG) were measured using 17 inertial sensors design to capture full body movements, while rigidity, and postural instability were assessed using clinical evaluations. Cognition was also assessed using the mini-mental state examination. Success criteria were set for each ADL using the time needed to perform the task and errors measured in 69 age-gender-matched healthy controls. Binary logistic regressions were used to identify symptoms influencing success or failure for each activity. Receiver operating characteristic curves were computed on each significant symptom, and Youden indexes were calculated to determine the critical level of symptomatology at which the performance significantly changed.Results: Results show that 97.7% of patients who presented with LID during the experiment also presented with at least one cardinal motor symptom. On average, patients took more time and did more errors during ADL. Multivariate analyses revealed that for the great majority of ADL, LID were not associated with worsening of performance; however, postural instability, tremor, rigidity, and cognitive decline significantly decreased the odds of success.Conclusions: Residual symptoms of PD, such as tremor, rigidity, and postural instability still present at peak-dose were more problematic than LID in the performance of ADL for patients experiencing slight-to-moderate LID. We also found that cognitive decline was associated with decreased performance in certain tasks. Therefore, a strategy using lower doses of medication to manage LID may be counterproductive since it would not address most of these symptoms already present in patients.
Highlights
The impact of levodopa-induced dyskinesia (LID) on the daily lives of patients with Parkinson’s disease (PD) remains to be determined
Data were collected in three Canadian research institutes: the Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, the Institut de Réadaptation en Déficience Physique de Québec, and the Movement Disorders Program of the University of Calgary, from June 2016 until June 2017. 69 healthy control participants were recruited through the Centre de Recherche de l’Institut universitaire de gériatrie de Montréal to provide a “normal” baseline of behavior during the performance of each activities of daily living (ADL)
After examining questionable cases where movement patterns did not seem to meet the characteristics of peak-dose choreic-type LID, four patients were identified as false-positive and were excluded from further analyses, while eight false-negatives were added back to the sample of patients having LID following video analyses
Summary
The impact of levodopa-induced dyskinesia (LID) on the daily lives of patients with Parkinson’s disease (PD) remains to be determined. Evidence suggests that cardinal motor symptoms of PD may coexist with LID, but their impact on activities of daily living (ADL) relative to LID is not known. The great majority of those studies used questionnaires to assess the symptomatology as well as ADL and QoL, which can be impacted by recall issues, anosognosia [16,17,18], depression or anxiety [15, 19, 20] To counteract these issues, some studies used a more quantitative approach where motor performance of patients having LID was compared with those of patients without LID and healthy controls in manual tracking tasks requiring high level of precision [21, 22]. We demonstrated that patients having LID could experiment other motor symptoms such as tremor, bradykinesia, rigidity, or postural instability concomitantly with peak-dose LID [24]
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