Objective: Against a background of the national and international Parkinson’s disease (PD) treatment guidelines, the aim of this study was to investigate to which degree the recommendations are followed in the treatment of non-motor symptoms (NMS) in late stage PD.

Background: National as well as international PD treatment guidelines are available. Previous research has shown that a large range of NMS, particularly neuropsychiatric symptoms, are pronounced in late stage PD. Multinational analyses have suggested that current treatment is insufficient and could be improved.

Method: This cohort constitutes the Swedish part of the European multicenter study Care of Late Stage Parkinsonism (CLaSP). Late stage PD was defined: Hoehn and Yahr IV-V in “on” and/or ≤ 50% on the Schwab & England ADL Scale. NMS were assessed with the NMS Scale (NMSS, 0-360, each item 0-12). Cognition was assessed with the Mini-Mental State Examination (MMSE, 0-30). Depressive symptoms were assessed with the Geriatric Depression Scale (GDS-30, 0-30). Symptomatic individuals were defined as ≥ 6 on an item of the NMSS; for dementia cutoff ≤ 18 on the MMSE; for depression cutoff ≥ 10 on the GDS.

Results: The study consisted of 107 patients, median age 78 years and disease duration 15 years, 74% in HY IV. All individuals exhibited NMS to various degree and severity, median NMSS score was 91. The results showed that among symptomatic individuals: for depressive symptoms, 36 of 63 (57%) were treated with antidepressants; for hallucinations and delusions, 9 of 18 (50%) and 5 of 13 (39%) with antipsychotics; for dementia, 9 of 27 (33%) with acetylcholinesterase inhibitor rivastigmine and 1 (4%) with donepezil. For orthostatic hypotension, 11 of 19 (58%) with light headedness and 7 of 8 (88%) with fainting were treated with antihypotensives; for sialorrhea, 2 of 42 (5%) with botulinum toxin; for constipation, 19 of 35 (54%) with laxatives. For insomnia, 4 of 16 (25%) were treated with hypnotics and for daytime sleepiness, 1 of 29 (3%) with psychostimulants.

Conclusion: The results confirm that NMS are common and pronounced in late stage PD and the present analyses strongly suggest a clear need for clinicians to further screen for and treat NMS also in this group. Optimizing treatment of NMS according to the national and international treatment guidelines may improve symptomatology and enhance quality of life in late stage PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/compliance-with-national-and-international-guidelines-in-the-treatment-of-non-motor-symptoms-in-late-stage-parkinsons-disease/