Module 1: Redefining Treatment Success in Patients With Parkinsons Disease

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Module 1
Redefining Treatment Success in Patients With
Parkinsons Disease
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Parkinsons Disease (PD)

• Chronic, progressive, neurologic disorder1,2
• Characterized by motor and nonmotor symptoms
• Pathogenesis involves degeneration of
  dopaminergic neurons in substantia nigra
• Direct and indirect costs associated with PD
  exceed 20 billion annually in United States3
• With aging population, burden of PD continues to
  increase
• Number of PD cases in individuals 50 years
  predicted to reach 8.7 million worldwide in next
  25 years4

1. Fahn and Sulzer. NeuroRx. 20041(1)139-154.
2. Jankovic. J Neurol Neurosurg Psychiatry.
200879(4)368-376. 3. Weintraub et al. Am J
Manag Care. 200814(2)S49-S58. 4. Dorsey et al.
Neurology. 200768(5)384-386.
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Age-Specific Prevalence of PD
Prevalence of PD, millions
PD, Parkinsons disease UK, United Kingdom US,
United States. Dorsey et al. Neurology.
200768(5)384-386.
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Motor Features of PD
PD, Parkinsons disease. 1. Jankovic. J Neurol
Neurosurg Psychiatry. 200879(4)368-376. 2.
Bhidayasiri. Postgrad Med J. 200581(962)756-762.
3. Berardelli et al. Brain. 2001124(pt
111)2131-2146. 4. Weintraub et al. Am J Manag
Care. 200814(2 suppl)S40-S48.
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PD Rating Scales Motor Symptoms

• Hoehn and Yahr scale
• 0 (no signs of disease) to 5 (wheelchair-bound)1,2
  
• Valuable for broadly classifying disease
  severity1,2
• UPDRS3,4
• Widely employed for assessing disability
• 70 of physicians incorporate into clinical
  practice
• Comprehensive assessment of motor symptoms
• MDS-UPDRS3
• Modified UPDRS to integrate nonmotor symptoms
• Currently being validated

MDS-UPDRS, Movement Disorder Society-Unified
Parkinsons Disease Rating Scale PD, Parkinsons
disease UPDRS, Unified Parkinsons Disease
Rating Scale. 1. Hoehn and Yahr. Neurology.
196717(5)427-442. 2. Jankovic. J Neurol
Neurosurg Psychiatry. 200879(4)368-376. 3.
Goetz et al. Mov Disord. 200722(1)41-47. 4. The
Unified Parkinsons Disease Rating Scale (UPDRS)
status and recommendations. Mov Disord.
200318(7)738-750.
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UPDRS Points Distribution1-3
Intellectual impairment, thought disorder,
depression, motivation
Speech, salivation, swallowing, handwriting,
using utensils, getting dressed, hygiene,
falling, freezing of gait, walking, tremor,
sensory complaints
Dyskinesia, clinical fluctuations, other
complications
Speech, facial expression, tremor at rest,
rigidity, finger taps, hand movements, leg
agility, rising from chair, posture, gait,
postural stability, bradykinesia
UPDRS, Unified Parkinsons Disease Rating
Scale. 1. The Unified Parkinsons Disease Rating
Scale (UPDRS) status and recommendations. Mov
Disord. 200318(7)738-750. 2. Hoehn and Yahr
staging of Parkinson's disease, Unified Parkinson
disease rating scale (UPDRS), and Schwab and
England activities of daily living. National
Parkinson Foundation. http//www.parkinson.org/NET
COMMUNITY/Page.aspx?pid367srcid 202. Accessed
July 1, 2008. 3. Waters CH. Diagnosis. In
Diagnosis and management of Parkinson's disease.
5th ed. Caddo, OK Professional Communications,
Inc 200663-102.
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Nonmotor Features of PD
PD, Parkinsons disease REM, rapid eye
movement. 1. Thanvi et al. Postgrad Med J.
200379(936)561-565. 2. Fahn and Sulzer.
NeuroRx. 20041(1)139-154. 3. Jankovic. J Neurol
Neurosurg Psychiatry. 200879(4)368-376.
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Early Nonmotor Signs of PD

• Probable early signs
• Constipation
• Olfactory deficit
• REM sleep behavior disorder
• Depression
• Possible early signs
• Apathy
• Fatigue
• Anxiety

PD, Parkinsons disease REM, rapid eye
movement. Chaudhuri et al. Lancet Neurol.
20065(3)235-245.
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PD Rating Scales HRQOL
ADL, activities of daily living HRQOL,
health-related quality of life PD, Parkinsons
disease PDQ, Parkinsons Disease Questionnaire
PDQL, Parkinsons Disease Quality of Life
Questionnaire PDQUALIF, Parkinsons Disease
Quality of Life Scale PIMS, Parkinsons Impact
Scale. 1. Jenkinson et al. Age Ageing.
199726(5)353-357. 2. Peto et al. Qual Life Res.
19954(3)241-248. 3. Welsh et al. Mov Disord.
200318(6)637-645. 4. de Boer et al. J Neurol
Neurosurg Psychiatry. 199661(1)70-74. 5. Calne
et al. Adv Neurol. 200391115-122.
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PD Symptoms Associated With Poor HRQOL
Mean PDQ-30 scores,
HRQOL, health-related quality of life PD,
Parkinsons disease PDQ, PD Questionnaire.
Schrag et al. J Neurol Neurosurg Psychiatry.
200069(3)308-312.
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Pharmacologic Therapies for PD
COMT, catechol-O-methyltransferase inhibitor
MAO-B, monoamine oxidase-B PD, Parkinsons
disease.
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Summary

• Global burden of PD will increase over next 25
  years
• Diagnosing PD is challenging
• Recognition of subtle, nonmotor signs crucial for
  early diagnosis
• Effective management of PD should involve
  individualized, patient-focused perspective
• Minimize disability
• Improve HRQOL
• Achieve treatment success

HRQOL, health-related quality of life PD,
Parkinsons disease.