Improvement by Medication Less than Expected in Parkinson's Disease: Blinded Evaluation of Levodopa Response

Mette Niemann Johansen, Anna Handberg, Mohamed El Haddouchi, Josefine Grundtvig, Steen Rusborg Jensen, Lisette Salvesen, Annemette Løkkegaard

Abstract

BACKGROUND: The latest Movement Disorder Society (MDS) diagnostic criteria require a good and sustained response to medication to get a diagnosis of Parkinson's disease, PD.

OBJECTIVE: The aim of this study was to evaluate levodopa response in a group of patients with probable PD, diagnosed by movement disorder specialists.

METHODS: An acute levodopa challenge test (LDCT) was performed after pausing the dopaminergic medication for 6 half-times. The motor part of the Unified Parkinson's Disease Rating Scale was performed in the OFF-state and after LDCT (ON). A good effect was defined as >30% improvement. A video-protocol was used to secure standardized motor examination with blinded assessments of the UPDRS-III OFF and ON. An age-matched group of control subjects (CS) was included but did not go through LDCT. All participants were evaluated with Montreal Cognitive Assessment (MoCA) and Beck's Depression Inventory (BDI).

RESULTS: In the statistical analysis, 37 patients were included. Twenty-one patients showed an improvement ≤30%, while 16 patients showed an improvement >30%. LDCT showed an overall mean improvement of 27.3% of motor UPDRS. In 43.2%, there was a discrepancy between the effect seen with the LDCT and the patients' self-perceived medicine evaluation. Patients with PD had a significantly lower MoCA score and more depressive symptoms compared to CS.

CONCLUSIONS: We showed an acute effect of levodopa using LDCT that was around 30% improvement. While it lends support to the use of this limit in the MDS diagnostic criteria, an acute effect of less than 30% should be considered acceptable in some patients. Our study highlights a discrepancy in the objective measure of medicine effect on motor symptoms and the patient's subjective evaluation.

Original languageEnglish
Article number2649578
JournalParkinson's Disease Update
Volume2024
Pages (from-to)2649578
ISSN2090-8083
DOIs
Publication statusPublished - 2024

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