Heidemarie Zach1, Michiel Dirkx2, Jaco W Pasman2, Bastiaan R Bloem2, Rick C Helmich2. 1. Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands; Department of Neurology, Medical University of Vienna, Vienna, Austria. Electronic address: heidemarie.zach@meduniwien.ac.at. 2. Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands.
Abstract
BACKGROUND: Dopaminergic medication adjustments in Parkinson's disease are often solely based on patient reports. However, it is unclear how well patient-based ratings of the levodopa response correlate with clinician-based ratings, and whether this correlation differs between motor symptoms. Here we compare patient-clinician agreement for the effect of levodopa on resting tremor and bradykinesia/rigidity. Furthermore, given patients' reports that tremor is most troublesome during stress, we test for differences in patient-clinician agreement between tremor at rest and stress-induced tremor. METHODS: We included 42 tremulous Parkinson patients, who were clinically rated (using the MDS-UPDRS) in a practically defined OFF-state and after levodopa-benserazide 200/50 mg. Using accelerometry, we quantified the effect of dopaminergic medication and behavioral context (rest vs. cognitive stress) on tremor intensity. Patients rated medication effects on tremor and bradykinesia/rigidity using visual analogue scales. RESULTS: There was only moderate patient-clinician agreement for the effect of levodopa on bradykinesia/rigidity (R2 = 0.18; p < 0.01), and a tendency towards larger agreement for tremor (R2 = 0.44; p < 0.001; difference between correlation coefficients: z = 1.64; p = 0.051). Patient ratings of tremor changes correlated significantly better with accelerometry for tremor during cognitive stress (R2 = 0.35; p < 0.001) vs. tremor at rest (R2 = 0.12; p < 0.05; difference: z = -2.35, p < 0.01). CONCLUSION: The moderate correlations between patient ratings and clinical/accelerometry changes indicate the need for methods to better monitor symptom severity and impairments in daily life, for example wearable sensors. Our findings also suggest that context matters: Parkinson patients' subjective experience of levodopa effectiveness on tremor was largely based on the ability of levodopa to reduce tremor during cognitive stress.
BACKGROUND: Dopaminergic medication adjustments in Parkinson's disease are often solely based on patient reports. However, it is unclear how well patient-based ratings of the levodopa response correlate with clinician-based ratings, and whether this correlation differs between motor symptoms. Here we compare patient-clinician agreement for the effect of levodopa on resting tremor and bradykinesia/rigidity. Furthermore, given patients' reports that tremor is most troublesome during stress, we test for differences in patient-clinician agreement between tremor at rest and stress-induced tremor. METHODS: We included 42 tremulous Parkinsonpatients, who were clinically rated (using the MDS-UPDRS) in a practically defined OFF-state and after levodopa-benserazide 200/50 mg. Using accelerometry, we quantified the effect of dopaminergic medication and behavioral context (rest vs. cognitive stress) on tremor intensity. Patients rated medication effects on tremor and bradykinesia/rigidity using visual analogue scales. RESULTS: There was only moderate patient-clinician agreement for the effect of levodopa on bradykinesia/rigidity (R2 = 0.18; p < 0.01), and a tendency towards larger agreement for tremor (R2 = 0.44; p < 0.001; difference between correlation coefficients: z = 1.64; p = 0.051). Patient ratings of tremor changes correlated significantly better with accelerometry for tremor during cognitive stress (R2 = 0.35; p < 0.001) vs. tremor at rest (R2 = 0.12; p < 0.05; difference: z = -2.35, p < 0.01). CONCLUSION: The moderate correlations between patient ratings and clinical/accelerometry changes indicate the need for methods to better monitor symptom severity and impairments in daily life, for example wearable sensors. Our findings also suggest that context matters: Parkinsonpatients' subjective experience of levodopa effectiveness on tremor was largely based on the ability of levodopa to reduce tremor during cognitive stress.
Authors: Yeşim Güzey Aras; Belma Doğan Güngen; Türkan Acar; Bilgehan A Acar; Sena Boncuk; Halil A Eryilmaz Journal: Noro Psikiyatr Ars Date: 2022-08-19 Impact factor: 1.066
Authors: Serene S Paul; Leland E Dibble; Genevieve N Olivier; Christopher Walter; Kevin Duff; Sydney Y Schaefer Journal: Behav Brain Res Date: 2019-09-14 Impact factor: 3.332
Authors: Mathias Baptiste Correno; Clint Hansen; Matthias Chardon; Tracy Milane; Edoardo Bianchini; Nicolas Vuillerme Journal: Int J Environ Res Public Health Date: 2022-10-06 Impact factor: 4.614