improvement of life quality and non motor symptoms relief in patients with advanced parkinson's...

Improvement of life quality and non motor symptoms relief in

patients with advanced Parkinson's disease.

Natalia PrițcanAndra OlteanDoctor Jozsef Attila SzaszDoctor Viorelia Constantin

Faculty of Medicine, UMPh Targu MureşDepartment of Neurology II, Faculty of Medicine, UMPh Targu Mureş

Introduction

Parkinson’s Disease is a chronic, progressive neurologic disease that is characterised by four cardinal motor manifestations: tremor at rest, rigidity, bradykinesia and postural instability.

Although still considered a paradigmatic movement disorder, Parkinson’s disease (PD) is associated with a broad spectrum of non-motor symptoms.

Non-motor symptoms completes the clinical picture of advanced Parkinson's disease and contribute to severe disability, impaired quality of life, and shortened life expectancy.

The clinical diagnosis of Parkinson's disease rests on the identification of the characteristics related to dopamine deficiency that are a consequence of degeneration of the substantia nigra pars compacta.

Non-dopaminergic and non-motor symptoms are sometimes present before diagnosis and almost inevitably emerge with disease progression.

Treatments and drugs

Carbidopa-levodopa Levodopa-carbidopa intestinal gel Dopamine agonists.  Deep brain stimulationMAO-B inhibitorsCOMT inhibitorsAnticholinergicsAmantadine

AimThe present study aims to evaluate the progress of non motor symptoms in patients with advanced Parkinson’s disease treated with Levodopa/Carbidopa intestinal gel (Duodopa) over a period of two years.

The evolution of the pacients life quality was also monitored and studied.

Material and method • We performed a retrospective study of 17 patients with advanced

Parkinson’s disease, hospitalized in Neurology Clinic of Targu Mures County Hospital which were selected for treatment with Duodopa.

• For each patient the revised questionnaire ” Non-Motor Symptom assessment scale for Parkinson’s Disease” was applied along with a questionnaire on quality of life.

• Questionnaires were completed by patients at baseline, after six, twelve, eighteen months of tratement and after two years.

• For data analysis we used two statistical tests: Kruskal-Wallis test and Chi-squared test.

The used scale for Non-motor symptoms comprises 9 domains: • Cardiovascular • Sleep • Mood • Perceptual problems • Attention/Memory • Gastrointestinal tract• Urinary • Sexual function • Miscellaneous

Each symptom included in this scale was scored respecting the severity and the frequency.

For assessing the quality of life we used a questionnaire composed of eight common situations of Parkinson's disease clinical presentation.

M-58.9%F-41.1%

Main age-65.4 years

70-79→41.1%60-69→35.2%50-59 →17.6%40-49 →5.8%

Domain 1 Cardiovascular Kruskal-Wallis test P=0.05

Domain 2 Sleep/fatigue P=0.87

Domain 3 Mood/cognition P=0.26

Domain 4 Perceptual problems, hallucinations P=0.87

PERCEPTIE, HALUCINATIE

0

5

10

15

20

25

30

35

40

45

50

INCLUDERE 6 LUNI 12 LUNI 18 LUNI 24 LUNI

Domain 5 Attention/memory P=0.72

Domain 6 Gastrointestinal tract P=0.047

Domain 7 Urinary P=o.98

Domain 8 Sexual function P=0.16

Domain 9Miscellaneous•Pain•Changes in ability to taste or smell•Changes in weight•Excessive sweating P=0.75

Improvement of life quality (1)Improvement of life quality (1)

Was it hard to move in public? P=0.29 44.3% sometimes 19% often 6.3% never 15.2% rarely 15.2% all the time

Was it hard for you to get dressed? P=0.97 39.2% sometimes 16.5% often 16.5% never 11.4% rarely 16.5% all the time

0 6m 12 m 18m 24 m

0 6m 12 m 18m 24 m

Improvement of life quality (2)Improvement of life quality (2)

Did you have problems in your relationships with close people ? P=0.36

20.3% sometimes3.8% often57% never19% rarely0% all the time

Did you feel deviated ? P=0.1 41.8% sometimes 15.2% often 22.8%never 10.1%rarely 10.1%all the time

0 6m 12 m 18m 24 m

0 6m 12 m 18m 24 m

Improvement of life quality (3)Improvement of life quality (3)

Did you have difficulty concentrating? P=0.824

24.1% sometimes7.6% often50.6% never17.7% rarely0% all the time

Did you feel that you can not properly communicate with people ? P=0.05

34.2% sometimes13.9% often35.4% never15.2% rarely1.3% all the time

0 6m 12 m 18m 24 m

0 6m 12 m 18m 24 m

Improvement of life quality (4)Improvement of life quality (4)

Did you have muscular pain or spasms? P=0.8329.1% sometimes27.8% often10.1% never24.1% rarely8.9% all the time

Did you feel embarrassed because you have Parkinson's disease? P=0.2

16.5% sometimes13.9% often35.4% never19% rarely15.2% all the time

0 6m 12 m 18m 24 m

0 6m 12 m 18m 24 m

Conclusions:• After 24 months of tratement with Duodopa intestinal gel, we noticed a

significant statistical improvement of gastrointestinal symptoms.

• The evolution of cardiovascular symptoms during two years of treatment with Duodopa had a slightly unfavorable course, with an increase in score and a value of P at limit.

• There was an improvement of the score but without statistical significance, in the next areas:mood/cognition, sleep/fatigue and sexual function.

• Over two years of study, patients reported no impairment of relationships and no difficulty of concentrating.

• The situations contained in the questionnaire on quality of life did not present a statistically significant evolution.

Thank you!