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Treatment Responsiveness of Motor Features in Parkinson's Disease: A Matched Case‐Control Analysis
Author(s) -
Macleod Angus D.,
Counsell Carl E.
Publication year - 2020
Publication title -
movement disorders clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.754
H-Index - 18
ISSN - 2330-1619
DOI - 10.1002/mdc3.12856
Subject(s) - medicine , confidence interval , cohort , levodopa , parkinson's disease , gait , physical medicine and rehabilitation , physical therapy , disease
ABSTRACT Background Treatment response in PD is important clinically and for research diagnostic criteria, but few objective data show treatment‐responsiveness of PD motor features. Objectives To evaluate the treatment response of motor features to moderate treatment doses in a “real‐world” PD cohort. Methods We analyzed data from a community‐based incident cohort of PD in North‐East Scotland (PINE study). We assessed change in the UPDRS motor scale and its individual items over a period of up to 13 months comparing (1) patients with an increase of at least 300 mg of levodopa‐equivalent dose (LED) and (2) patients without treatment change, matched for age, sex, and disease duration. Results We identified 101 matched pairs of patients with and without a treatment increase. LED increases were mostly 300 to 375 mg/day. Forty‐two percent with treatment increase had ≥30% improvement in overall UPDRS motor score, a further 35% had substantial subjective improvement, but only 1 had an objective excellent (>70%) treatment response. Women responded better than men by 5.4 points (95% confidence interval [CI]: 2.7–8.1). All motor features improved with treatment, but after adjustment for age, sex, and initial score, only rest tremor ( P < 0.001), rigidity ( P = 0.01), bradykinesia (<0.001), posture ( P = 0.01), and gait ( P = 0.03) had significant improvements, compared to those with no treatment change. Dopa‐less‐responsive motor items, taken together, had small statistically significant relative improvements (1.1‐point difference [95% CI: 0.4–1.8]; P = 0.004). Conclusions Motor items sometimes previously considered dopa unresponsive have small improvements with moderate LED increases. Women respond better than men. Excellent treatment responses are uncommon. These data can inform clinical decisions about treatment.