Method of Levodopa Response Calculation Determines Strength of Association With Clinical Factors in Parkinson Disease
BackgroundThe levodopa challenge test is routinely used in Parkinson disease (PD) to determine a patient’s motor improvement following levodopa administration [levodopa response (LR)]. LR is most commonly reported as a percent OFF to ON change in the Unified Parkinson Disease Rating Scale (UPDRS) pa...
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doaj-936087a8290642afb3812f156e8aea6f2020-11-24T23:02:55ZengFrontiers Media S.A.Frontiers in Neurology1664-22952018-05-01910.3389/fneur.2018.00260355629Method of Levodopa Response Calculation Determines Strength of Association With Clinical Factors in Parkinson DiseaseMarcus Pieterman0Scott Adams1Scott Adams2Mandar Jog3Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, CanadaSchool of Communication Sciences and Disorders, University of Western Ontario, CanadaDepartment of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, CanadaDepartment of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, CanadaBackgroundThe levodopa challenge test is routinely used in Parkinson disease (PD) to determine a patient’s motor improvement following levodopa administration [levodopa response (LR)]. LR is most commonly reported as a percent OFF to ON change in the Unified Parkinson Disease Rating Scale (UPDRS) part III score, and occasionally as an absolute difference in score. This inconsistency in LR determination alters how clinical factors such as patient age and disease duration are understood in relation to LR in PD.ObjectiveThe aim of this study was to compare the calculation of the LR as either a percent change or difference in UPDRS-III motor score between OFF and ON medication. These two scores were then used to correlate to disease duration, patient age, levodopa duration, levodopa equivalent dose (LED), OFF score, cognition, mood, gait, and quality of life (QOL).Methods70 PD patients underwent the levodopa challenge test. The UPDRS-III motor examination was performed in the defined OFF and ON medication states to determine LR. Each patient was assessed after 12–14 h without anti-parkinsonian medication and then given three 100/25 mg levodopa/carbidopa tablets. LR was reported as both a difference in score [OFF − ON; absolute LR (aLR)] and as a percent change in score [(OFF − ON)/OFF*100%; %LR]. Patients completed the following non-motor symptom assessment scales: Montreal Cognitive Assessment, Freezing of Gait Questionnaire, Activities-specific Balance Confidence Scale, Parkinson’s Disease Questionnaire, and Geriatric Depression Scale. The effect of the LR calculation method was correlated to the clinical measures.ResultsThe aLR was significantly associated with disease duration (r = 0.40), levodopa duration (r = 0.47), OFF motor score (r = 0.58), and LED (r = 0.31), but not age. The aLR was also found to have a significant relationship with clinical scales assessing cognition (r = 0.41), freezing of gait (r = 0.35), QOL (r = 0.40), and depression (r = 0.30). By contrast, the more commonly used %LR demonstrated no significant relationships with any of the variables tested.ConclusionAlthough the %LR is more commonly employed in clinical protocols and research studies, the aLR is the superior method for reporting motor response to levodopa in PD given its significant associations with the clinical factors evaluated.http://journal.frontiersin.org/article/10.3389/fneur.2018.00260/fullParkinson diseaselevodopalevodopa responselevodopa challenge testUnified Parkinson Disease Rating Scaledisease duration |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Marcus Pieterman Scott Adams Scott Adams Mandar Jog |
spellingShingle |
Marcus Pieterman Scott Adams Scott Adams Mandar Jog Method of Levodopa Response Calculation Determines Strength of Association With Clinical Factors in Parkinson Disease Frontiers in Neurology Parkinson disease levodopa levodopa response levodopa challenge test Unified Parkinson Disease Rating Scale disease duration |
author_facet |
Marcus Pieterman Scott Adams Scott Adams Mandar Jog |
author_sort |
Marcus Pieterman |
title |
Method of Levodopa Response Calculation Determines Strength of Association With Clinical Factors in Parkinson Disease |
title_short |
Method of Levodopa Response Calculation Determines Strength of Association With Clinical Factors in Parkinson Disease |
title_full |
Method of Levodopa Response Calculation Determines Strength of Association With Clinical Factors in Parkinson Disease |
title_fullStr |
Method of Levodopa Response Calculation Determines Strength of Association With Clinical Factors in Parkinson Disease |
title_full_unstemmed |
Method of Levodopa Response Calculation Determines Strength of Association With Clinical Factors in Parkinson Disease |
title_sort |
method of levodopa response calculation determines strength of association with clinical factors in parkinson disease |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2018-05-01 |
description |
BackgroundThe levodopa challenge test is routinely used in Parkinson disease (PD) to determine a patient’s motor improvement following levodopa administration [levodopa response (LR)]. LR is most commonly reported as a percent OFF to ON change in the Unified Parkinson Disease Rating Scale (UPDRS) part III score, and occasionally as an absolute difference in score. This inconsistency in LR determination alters how clinical factors such as patient age and disease duration are understood in relation to LR in PD.ObjectiveThe aim of this study was to compare the calculation of the LR as either a percent change or difference in UPDRS-III motor score between OFF and ON medication. These two scores were then used to correlate to disease duration, patient age, levodopa duration, levodopa equivalent dose (LED), OFF score, cognition, mood, gait, and quality of life (QOL).Methods70 PD patients underwent the levodopa challenge test. The UPDRS-III motor examination was performed in the defined OFF and ON medication states to determine LR. Each patient was assessed after 12–14 h without anti-parkinsonian medication and then given three 100/25 mg levodopa/carbidopa tablets. LR was reported as both a difference in score [OFF − ON; absolute LR (aLR)] and as a percent change in score [(OFF − ON)/OFF*100%; %LR]. Patients completed the following non-motor symptom assessment scales: Montreal Cognitive Assessment, Freezing of Gait Questionnaire, Activities-specific Balance Confidence Scale, Parkinson’s Disease Questionnaire, and Geriatric Depression Scale. The effect of the LR calculation method was correlated to the clinical measures.ResultsThe aLR was significantly associated with disease duration (r = 0.40), levodopa duration (r = 0.47), OFF motor score (r = 0.58), and LED (r = 0.31), but not age. The aLR was also found to have a significant relationship with clinical scales assessing cognition (r = 0.41), freezing of gait (r = 0.35), QOL (r = 0.40), and depression (r = 0.30). By contrast, the more commonly used %LR demonstrated no significant relationships with any of the variables tested.ConclusionAlthough the %LR is more commonly employed in clinical protocols and research studies, the aLR is the superior method for reporting motor response to levodopa in PD given its significant associations with the clinical factors evaluated. |
topic |
Parkinson disease levodopa levodopa response levodopa challenge test Unified Parkinson Disease Rating Scale disease duration |
url |
http://journal.frontiersin.org/article/10.3389/fneur.2018.00260/full |
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