Burden of non-motor symptoms in Parkinson's disease patients predicts improvement in quality of life during treatment with levodopa-carbidopa intestinal gel

Eur J Neurol. 2019 Apr;26(4):581-e43. doi: 10.1111/ene.13847. Epub 2018 Dec 26.

Abstract

Background and purpose: GLORIA, a registry conducted with 375 advanced Parkinson's disease patients treated with levodopa-carbidopa intestinal gel (LCIG) for 24 months in routine clinical care, demonstrated significant reductions from baseline in 'off' time and 'on' time with dyskinesia and improvements in the Non-Motor Symptom Scale (NMSS) total and individual domain scores, and in Parkinson's Disease Questionnaire 8 item (PDQ-8) total score.

Methods: Associations between baseline NMSS burden (NMSB), the multi-domain NMSS total score and the PDQ-8 total score were investigated for 233 patients. Baseline NMSB was assigned to five numerical categories defined by the NMSS total cutoff scores (0-20, 21-40, 41-60, 61-80 and >80). Pearson and Spearman correlations were calculated at month 24.

Results: The response of LCIG was assessed using validated criteria after 24 months. The proportion of patients decreasing ≥ 30 NMSS score points was 47% in the most affected NMSB category (NMSS total score > 80). A positive association was noted between baseline NMSB and NMSS total score (0.57, P < 0.0001), as well as between NMSS total score and PDQ-8 total score (0.46, P < 0.0001). Associations between improvements of the NMSS domain sleep/fatigue and PDQ-8 total score (0.32, P = 0.0001) as well as between the NMSS domain mood/cognition and PDQ-8 total score (0.37, P < 0.0001) were also shown.

Conclusions: This analysis demonstrated positive associations between NMSS baseline burden and improvements of non-motor symptoms. Improvements of non-motor symptoms were associated with improved quality of life in advanced parkinsonian patients during a 2-year treatment with LCIG and reflect the long-term non-motor efficacy of this treatment.

Keywords: Parkinson's disease; levodopa-carbidopa intestinal gel; non-motor symptoms; quality of life; routine patient care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antiparkinson Agents / administration & dosage
  • Antiparkinson Agents / therapeutic use*
  • Carbidopa / administration & dosage
  • Carbidopa / therapeutic use*
  • Cost of Illness
  • Drug Combinations
  • Female
  • Gels / administration & dosage
  • Gels / therapeutic use
  • Humans
  • Levodopa / administration & dosage
  • Levodopa / therapeutic use*
  • Male
  • Middle Aged
  • Parkinson Disease / diagnosis*
  • Parkinson Disease / drug therapy
  • Parkinson Disease / psychology
  • Quality of Life*
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Treatment Outcome

Substances

  • Antiparkinson Agents
  • Drug Combinations
  • Gels
  • carbidopa, levodopa drug combination
  • Levodopa
  • Carbidopa

Grants and funding