Volume 20, Issue 6 p. 726-733
Research Article

Identification of motor and nonmotor wearing-off in Parkinson's disease: Comparison of a patient questionnaire versus a clinician assessment

Mark Stacy MD

Corresponding Author

Mark Stacy MD

Duke University Medical Center, Durham, North Carolina, USA

Division of Neurology, Duke University Medical Center, 932 Morreene Road, Box 3333, Durham, NC 27705Search for more papers by this author
Annette Bowron RGN, MA

Annette Bowron RGN, MA

North Tyneside General Hospital, North Shields, United Kingdom

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Mark Guttman MD, FRCPC

Mark Guttman MD, FRCPC

University of Toronto, Division of Neurology, Toronto, Canada

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Robert Hauser MD, MBA

Robert Hauser MD, MBA

University of South Florida College of Medicine, Tampa, Florida, USA

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Kim Hughes

Kim Hughes

The Planning Shop International, London, United Kingdom

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Jan Petter Larsen MD, PhD

Jan Petter Larsen MD, PhD

Central Hospital of Rogaland, Stavanger, Norway

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Peter LeWitt MD

Peter LeWitt MD

Wayne State University School of Medicine, Detroit, Michigan, USA

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Wolfgang Oertel MD

Wolfgang Oertel MD

Center of Nervous Diseases, Philipps-University, Marburg, Germany

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Niall Quinn MA, MD, FRCP

Niall Quinn MA, MD, FRCP

Institute of Neurology, London, United Kingdom

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Kapil Sethi MD, FRCP

Kapil Sethi MD, FRCP

Medical College of Georgia, Augusta, Georgia, USA

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Fabrizio Stocchi MD, PhD

Fabrizio Stocchi MD, PhD

Institute of Neurology, IRCCS NEUROMED, Pozzilli, Italy

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First published: 17 February 2005
Citations: 182

Abstract

This study compares the sensitivity of a Patient Questionnaire versus information gathered by clinicians at a routine clinic visit in recognizing symptoms of wearing-off in early Parkinson's disease (PD). This Patient Questionnaire, containing 32 items representing a wide spectrum of motor and nonmotor wearing-off symptoms, was administered to subjects attending two PD clinics. The Patient Questionnaire results were compared to the information gathered by the clinician from the Unified Parkinson's Disease Rating Scale (UPDRS) Part IV, Question 36 and from a specific Clinical Assessment Question regarding loss of medication efficacy, wearing-off, sleepiness, dyskinesias, psychiatric complications, morning akinesia, other dopaminergic side effects, or none of the above. Examiners were blinded to study hypothesis and survey contents. Three hundred consecutive subjects with PD of <5 years duration were evaluated; the mean subject age was 72 ± 9.6 years and 60.2% were men. Subjects reporting wearing-off were significantly younger (69.9 vs. 74.7 years) and differed regarding duration of PD symptoms (3.7 vs. 3.1 years). Wearing-off was found in 181 subjects (62.6%) by one or more of the three measures. The most sensitive tool was the Patient Questionnaire, with 165 subjects (57.1%) indicating symptoms of wearing-off. Question 36 of the UPDRS was positive in 127 subjects (43.9%), and the Clinical Assessment Question identified 85 subjects (29.4%) as experiencing wearing-off. All of these results were found to differ significantly. The mean number of wearing-off symptoms reported by the 165 subjects indicating wearing-off on the clinical survey was 6.25, with tremor being the most common motor feature and tiredness the most common nonmotor feature. © 2005 Movement Disorder Society