A Real-World Study on Unstable Parkinson's Disease : Levodopa Dosage Management and the Role of Nonmotor Symptoms
Stocchi, Fabrizio (Institute for Research and Medical Care IRCCS San Raffaele Rome)
Kulisevsky, Jaime (Institut de Recerca Sant Pau)
Jost, Wolfgang (Parkinson-Klinik Ortenau)
Universitat Autònoma de Barcelona. Departament de medicina

Date:	2025
Abstract:	Parkinson's disease (PD) is a neurodegenerative disorder associated with motor and nonmotor symptoms. This study assesses levodopa dose management, the therapeutic goals of clinicians, the factors that influence clinicians' choice of therapy, and the role of nonmotor symptoms using real-world evidence from Germany, Italy, and Spain. To assess the management of unstable PD patients on levodopa-containing regimens, neurologists were asked to complete questionnaires (n = 181) and prospective electronic patient records (EPR) were collected (n = 2687). Neurologists were asked questions about their practice and approach to unstable PD patients. EPRs were completed by neurologists after each visit with patients, and the objectives of any changes to therapy were recorded. Seventy-four percent of neurologists cited "improving motor symptoms" as the main objective for increasing daily levodopa dose. This was also the main objective when starting an add-on (50%) and the main reason for selecting a new add-on therapy (29%). In comparison, reducing nonmotor symptoms, depression, and pain was rarely cited as either the main or secondary objective for a therapy selection (15%, 9%, and 9%, respectively) even when over 60% of unstable patients had pain or depression and 29% had both. When the importance of add-on therapy features was rated, "improve quality of life (QoL)" had the highest average score. Improving nonmotor symptoms, pain, and depression was among the lowest-rated therapy feature. These findings suggest that improving motor symptoms is a key driver of therapeutic choice. In prioritizing motor symptoms, neurologists may unintentionally neglect nonmotor symptoms, despite most patients suffering from pain or depression.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Parkinson's disease ; Levodopa ; Pain ; Depression ; Therapeutic goals
Published in:	Movement Disorders Clinical Practice, Vol. 12 (June 2025) , p. 2143-2153, ISSN 2330-1619

DOI: 10.1002/mdc3.70188
PMID: 40545913

11 p, 668.8 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles