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Motor complications in an incident Parkinson's disease cohort.
Eur J Neurol. 2016 Feb; 23(2):304-12.EJ

Abstract

BACKGROUND AND PURPOSE

Levodopa treatment in Parkinson's disease (PD) causes motor fluctuations and dyskinesias, but few data describe their development or severity in unselected incident cohorts.

METHODS

Demographic, clinical, treatment, smoking, caffeine and alcohol data from 183 people with PD were gathered from the Parkinsonism Incidence in Northeast Scotland (PINE) study, a community-based, incident cohort. With Kaplan-Meier survival analysis and Cox regression modelling the development, and severity, of dyskinesias and motor fluctuations and which factors independently influenced their onset were assessed.

RESULTS

After a mean follow-up of 59 months, 39 patients (21.3%) developed motor fluctuations and 52 (28.4%) developed dyskinesias. Kaplan-Meier estimates of the probability of motor fluctuations and dyskinesias after 5 years of dopaminergic treatment were 29.2% [95% confidence interval (CI) 21.5%-38.8%] and 37.0% (95% CI 28.5%-47.1%) respectively. 19.8% developed motor fluctuations requiring treatment changes but only 4.0% (95% CI 1.5%-10.4%) developed dyskinesias requiring treatment changes by 5 years. Cumulative levodopa dose [hazard ratio (HR) 1.38 (95% CI 1.19-1.60)], female sex [HR 2.41 (1.19-4.89)] and younger age at diagnosis [HR 1.08 (1.04-1.11)] were independently associated with development of motor fluctuations. Cumulative levodopa dose [HR 1.23 (1.08-1.40)] and female sex [HR 2.51 (1.40-4.51)] were independently associated with dyskinesias. In exploratory analyses, moderate caffeine exposure was associated with fewer motor fluctuations, longer symptom duration with more dyskinesias, and tremor at diagnosis with higher rates of both complications.

CONCLUSIONS

In this community-based incident PD cohort, severe dyskinesias were rare. Cumulative levodopa dose was the strongest predictor of both dyskinesias and motor fluctuations.

Authors+Show Affiliations

Division of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK.Division of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK.Division of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26074125

Citation

Scott, N W., et al. "Motor Complications in an Incident Parkinson's Disease Cohort." European Journal of Neurology, vol. 23, no. 2, 2016, pp. 304-12.
Scott NW, Macleod AD, Counsell CE. Motor complications in an incident Parkinson's disease cohort. Eur J Neurol. 2016;23(2):304-12.
Scott, N. W., Macleod, A. D., & Counsell, C. E. (2016). Motor complications in an incident Parkinson's disease cohort. European Journal of Neurology, 23(2), 304-12. https://doi.org/10.1111/ene.12751
Scott NW, Macleod AD, Counsell CE. Motor Complications in an Incident Parkinson's Disease Cohort. Eur J Neurol. 2016;23(2):304-12. PubMed PMID: 26074125.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Motor complications in an incident Parkinson's disease cohort. AU - Scott,N W, AU - Macleod,A D, AU - Counsell,C E, Y1 - 2015/06/13/ PY - 2015/01/26/received PY - 2015/04/06/accepted PY - 2015/6/16/entrez PY - 2015/6/16/pubmed PY - 2016/9/16/medline KW - Parkinson's disease KW - dyskinesias KW - levodopa KW - motor complications KW - motor fluctuations SP - 304 EP - 12 JF - European journal of neurology JO - Eur J Neurol VL - 23 IS - 2 N2 - BACKGROUND AND PURPOSE: Levodopa treatment in Parkinson's disease (PD) causes motor fluctuations and dyskinesias, but few data describe their development or severity in unselected incident cohorts. METHODS: Demographic, clinical, treatment, smoking, caffeine and alcohol data from 183 people with PD were gathered from the Parkinsonism Incidence in Northeast Scotland (PINE) study, a community-based, incident cohort. With Kaplan-Meier survival analysis and Cox regression modelling the development, and severity, of dyskinesias and motor fluctuations and which factors independently influenced their onset were assessed. RESULTS: After a mean follow-up of 59 months, 39 patients (21.3%) developed motor fluctuations and 52 (28.4%) developed dyskinesias. Kaplan-Meier estimates of the probability of motor fluctuations and dyskinesias after 5 years of dopaminergic treatment were 29.2% [95% confidence interval (CI) 21.5%-38.8%] and 37.0% (95% CI 28.5%-47.1%) respectively. 19.8% developed motor fluctuations requiring treatment changes but only 4.0% (95% CI 1.5%-10.4%) developed dyskinesias requiring treatment changes by 5 years. Cumulative levodopa dose [hazard ratio (HR) 1.38 (95% CI 1.19-1.60)], female sex [HR 2.41 (1.19-4.89)] and younger age at diagnosis [HR 1.08 (1.04-1.11)] were independently associated with development of motor fluctuations. Cumulative levodopa dose [HR 1.23 (1.08-1.40)] and female sex [HR 2.51 (1.40-4.51)] were independently associated with dyskinesias. In exploratory analyses, moderate caffeine exposure was associated with fewer motor fluctuations, longer symptom duration with more dyskinesias, and tremor at diagnosis with higher rates of both complications. CONCLUSIONS: In this community-based incident PD cohort, severe dyskinesias were rare. Cumulative levodopa dose was the strongest predictor of both dyskinesias and motor fluctuations. SN - 1468-1331 UR - https://www.unboundmedicine.com/medline/citation/26074125/Motor_complications_in_an_incident_Parkinson's_disease_cohort_ L2 - https://doi.org/10.1111/ene.12751 DB - PRIME DP - Unbound Medicine ER -