Objective: To compare the quality of life (QoL) in Parkinson’s Disease (PD) patients with and without morning akinesia (MA) in those using oral medications only and those who initiate device aided therapy (DAT).

Background: For PD patients, oral medications may wane in effect overnight, causing symptoms upon waking, making it hard to start their day before medication. Quantifying the burden of MA reinforces the importance of optimizing nighttime treatments or consider DAT for people who have excessive morning burden.

Method: Advanced PD patients were observed for 24 months between Nov 2020 and Mar 2024. Patients self-reported motor symptoms and QoL assessments. The QoL impact of MA, defined as reporting “OFF” status 1 hour after awakening from the first minimum 2 consecutive hours of sleep between 12am and 12pm on a PD diary, measured using the PD Questionnaire-39 (PDQ-39) summary index and its 8 dimensions, was assessed using a mixed model with repeated measures. Covariates included visit, treatment cohort, age, sex, PD duration, and history of levodopa-induced dyskinesia. Least square (LS) mean differences in the PDQ-39 score between MA and non-MA observations for all visits combined were evaluated overall and within treatment cohorts, categorized based on observed treatment during follow-up: oral PD medications or DAT initiated.

Results: Of the 229 patients enrolled, 184 remained on oral PD medications and 45 initiated DAT during follow-up. Demographics were similar across the 2 groups. The DAT cohort had less MA (27.7%) compared to the oral PD cohort (45.5%). The absence of MA compared to the presence of MA was significantly associated with improved PDQ-39 index scores overall (LS mean [CI] = -1.9 [-3.18, -0.67]) and within the DAT cohort (-8.1 [-13.5, -2.66]), both p<0.0060) (Fig 1). In the DAT cohort, better QoL scores were driven by the differences in 4 dimensions: mobility (LS mean [SE] = -9.9 [3.69]), activities of daily living (-10.9 [3.45]), cognition (-9.1 [3.90]), and bodily discomfort (-9.7 [2.93]), p<0.03.

Conclusion: QoL was significantly improved in the absence of MA. Scores were worse in those remaining on oral medications than those initiated on DATs. This underscores the impact of MA on PD patient’s QoL and stresses the importance of identifying frequent MA in PD patients so treatments can be optimized to improve QoL.

PDQ-39 and Morning Akinesia

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MDS Abstracts - https://www.mdsabstracts.org/abstract/quality-of-life-impact-on-adults-with-parkinsons-disease-experiencing-morning-akinesia-real-world-observational-findings/