Objective: To study the effect of age at onset on the medication profile of various Parkinson’s disease (PD) related medications.

Background: Multiple factors determine the choice of medications in patients with PD. It may depend on the disease factors, such as the age of the patient, the stage of the disease, the presence of motor fluctuations, and coexisting illnesses, on the patient factors such as affordability and accessibility, or on the experience and expertise of the treating physician.

Method: Interim data was analyzed for 379 patients with PD who were prospectively recruited in the YLOPD study (funded by the SKAN research trust) at NIMHANS, Bengaluru, India from July 2022 to December 2024. All subjects underwent detailed clinical assessment, including the MDS-UPDRS, and were subtyped into early-onset PD (EOPD) and late-onset PD (LOPD) based on a cut-off of 50 years (EOPD: <50 years, LOPD: ≥50 years). The treatment profile at the time of baseline assessment was tabulated including levodopa equivalent dose calculation. Statistical analysis for the influence of age at onset on the treatment profile was carried out with p<0.05 considered to be significant.

Results: The mean age at the onset of the cohort was 48.05±11.76 years, with 54.1% of the cohort constituting EOPD patients [Table1]. The most frequently prescribed medication was levodopa/carbidopa (LD/CD) in 93.9% (n=356) of the patients followed by dopamine agonists (DA) in 56.7% (n=216) {Figure1]. More than 50 different patterns were noted in prescription, with the most frequent pattern being monotherapy with LD/CD in 75 patients (19.8%) followed by the combination of LD/CD with DA in 63 patients (16.6%). 80% of the patients were on polytherapy. Patients with EOPD were more frequently on dopamine agonists (68.8% vs 42.5%, p<0.001), amantadine (28.3% vs 17.24%, p=0.014), and trihexyphenidyl (30.7% vs 10.5%, p<0.001) compared to patients with LOPD. Among the prescribing patterns, monotherapy with LD/CD was significantly more frequent in LOPD (20/205 vs. 73/174, p<0.001), whereas the combination of LD/CD with DA was more frequent in EOPD but not significant (38/205 vs. 25/174, p=0.33).

Conclusion: 80% of our patients were on polytherapy. Patients with EOPD are more likely to be prescribed dopamine agonists, amantadine, and trihexyphenidyl, and patients with LOPD are more likely to be on monotherapy with LD/CD.

Table 1

Figure 1

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MDS Abstracts - https://www.mdsabstracts.org/abstract/influence-of-age-at-onset-on-medication-profile-in-patients-with-parkinsons-disease-a-prospective-study-from-a-tertiary-care-center-in-india/