Motor complications in an incident Parkinson’s disease cohort

N. W. Scott, A. D. MacLeod (Corresponding Author), C. E. Counsell

Research output: Contribution to journalArticle

20 Citations (Scopus)
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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.
Original languageEnglish
Pages (from-to)304-312
Number of pages9
JournalEuropean Journal of Neurology
Volume23
Issue number2
Early online date13 Jun 2015
DOIs
Publication statusPublished - Feb 2016

Fingerprint

Dyskinesias
Parkinson Disease
Levodopa
Confidence Intervals
Sex Ratio
Caffeine
Therapeutics
Parkinsonian Disorders
Scotland
Tremor
Survival Analysis
Smoking
Alcohols
Incidence

Keywords

  • Parkinson's disease
  • motor fluctuations
  • dyskinesias
  • motor complications
  • levodopa

Cite this

Motor complications in an incident Parkinson’s disease cohort. / Scott, N. W.; MacLeod, A. D. (Corresponding Author); Counsell, C. E.

In: European Journal of Neurology, Vol. 23, No. 2, 02.2016, p. 304-312.

Research output: Contribution to journalArticle

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abstract = "Background and purposeLevodopa treatment in Parkinson's disease (PD) causes motor fluctuations and dyskinesias, but few data describe their development or severity in unselected incident cohorts.MethodsDemographic, 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.ResultsAfter 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.ConclusionsIn this community-based incident PD cohort, severe dyskinesias were rare. Cumulative levodopa dose was the strongest predictor of both dyskinesias and motor fluctuations.",
keywords = "Parkinson's disease, motor fluctuations, dyskinesias, motor complications, levodopa",
author = "Scott, {N. W.} and MacLeod, {A. D.} and Counsell, {C. E.}",
note = "Acknowledgements We acknowledge funding for the PINE study from Parkinson's UK, the Scottish Chief Scientist Office, the BMA Doris Hillier Award, RS Macdonald Trust, the BUPA Foundation, NHS Grampian Endowments and SPRING. We thank the patients for their participation and the research staff who collected data and supported the study database. Nicholas W Scott: no financial disclosures. Angus D Macleod: funded by a Clinical Academic Fellowship from the Scottish Chief Scientist Office; also received research funding from Parkinson's UK. Carl E Counsell: research funding from Parkinson's UK, Scottish Chief Scientist Office, National Institute of Health Research, and Engineering and Physical Sciences Research Council.",
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N1 - Acknowledgements We acknowledge funding for the PINE study from Parkinson's UK, the Scottish Chief Scientist Office, the BMA Doris Hillier Award, RS Macdonald Trust, the BUPA Foundation, NHS Grampian Endowments and SPRING. We thank the patients for their participation and the research staff who collected data and supported the study database. Nicholas W Scott: no financial disclosures. Angus D Macleod: funded by a Clinical Academic Fellowship from the Scottish Chief Scientist Office; also received research funding from Parkinson's UK. Carl E Counsell: research funding from Parkinson's UK, Scottish Chief Scientist Office, National Institute of Health Research, and Engineering and Physical Sciences Research Council.

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N2 - Background and purposeLevodopa treatment in Parkinson's disease (PD) causes motor fluctuations and dyskinesias, but few data describe their development or severity in unselected incident cohorts.MethodsDemographic, 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.ResultsAfter 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.ConclusionsIn this community-based incident PD cohort, severe dyskinesias were rare. Cumulative levodopa dose was the strongest predictor of both dyskinesias and motor fluctuations.

AB - Background and purposeLevodopa treatment in Parkinson's disease (PD) causes motor fluctuations and dyskinesias, but few data describe their development or severity in unselected incident cohorts.MethodsDemographic, 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.ResultsAfter 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.ConclusionsIn this community-based incident PD cohort, severe dyskinesias were rare. Cumulative levodopa dose was the strongest predictor of both dyskinesias and motor fluctuations.

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