Impact of initial treatment on future symptoms and quality of life in Parkinson's disease

Abstract

Objective To explore the effects of different initial drug treatment on motor symptoms, cognitive function and quality of life in patients with Parkinson's disease (PD). Methods Data of 134 PD patients who hospitalized in Tianjin Huanhu Hospital from January 2016 to January 2022 were collected. The patients were divided into levodopa and non⁃levodopa initial treatment groups basing on their initial therapy. The levodopa equivalent dose (LED) was calculated according to the anti⁃parkinsonism medications they were taking. The motor symptoms, cognitive function and quality of life were evaluated with Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS Ⅲ), Mini⁃Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and 39⁃Item Parkinson's Disease Questionnaire (PDQ⁃39). Additionally, the maximum improvement rate of the levodopa challenge test was calculated. The association between motor symptoms, cognitive function, quality of life, maximum improvement rate of the levodopa challenge test and initial drug treatment was analyzed by multiple linear stepwise regression. Results Compared with non⁃levodopa group, patients in levodopa group had higher MMSE score (Z=⁃3.200, P=0.001), MoCA score (Z=⁃2.736, P=0.006) and the maximum improvement rate of levodopa challenge test (t=⁃2.411, P=0.018), and lower PDQ⁃39 score (t=2.631, P=0.010). Multiple linear stepwise regression analysis showed that there was a positive linear regression relationship between the maximum improvement rate of the levodopa challenge test (standardized partial regression coefficient=0.222, P=0.008), MMSE score (standardized partial regression coefficient=0.278, P=0.001), MoCA score (standardized partial regression coefficient=0.241, P=0.005) and the initial treatment of levodopa, and there was a negative linear regression relationship between PDQ⁃39 score and the initial treatment of levodopa (standardized partial regression coefficient=⁃0.235, P=0.006). There was no significant association between initial treatment and UPDRSⅢ score (P=0.697). Conclusions The initial treatment has no different influence on motor symptom progress in patients with PD, however, patients may have more benefits in cognitive function and quality of life from levodopa initial therapy.

Keywords

• parkinson disease
• levodopa
• dopamine agonists
• initial treatment (not in mesh)