Objective:

1. Evaluate clinicians’ ability to recognise wearing-off compared with the Wearing Off Questionnaire-9 (WOQ-9)

2. Assess patient awareness of wearing-off symptoms

Background: Wearing off is a common complication of Parkinson’s, characterised by re-emergence of motor or non-motor symptoms prior to the next scheduled medication dose ¹ ². Its pathophysiology is thought to be linked to disease progression and pharmacokinetic limitations of dopaminergic therapy. Validated screening tools like WOQ-9 show high sensitivity, though clinical practice often relies solely on clinician judgement ³.

Method: An observational study was conducted at University Hospital Llandough Parkinson’s clinic (S. Wales, UK). Patients with a diagnosis of Parkinson’s attending routine follow-up appointments were asked to complete the WOQ-9 questionnaire in the waiting area. After their consultation, clinical documentation was reviewed to determine if clinicians had recorded wearing off or adjusted their medications to reflect the same. This was compared with the WOQ-9 results.

Results: 43 patients completed the questionnaire (63% male). Wearing off symptoms were highly prevalent, with 34 of 43 patients (79%) scoring positively on WOQ-9. Clinicians documented wearing off in 18 cases (41.9%). Patient self-awareness of wearing off was limited, with 12 out of 34 WOQ-9 positive patients (35.3%), with a higher percentage of females. WOQ-9 detected higher rates of wearing off in males (88.9%) compared to clinician recognition alone (33.3%). In contrast, rates in females were found to be comparable between both the WOQ-9 and clinician recognition (62.5% vs 56.3%). Patients who were WOQ-9 positive had a higher mean number of medications (8.26 vs 6.56) and co-morbidity burden (4.88 vs 2.89). 47% had ≤5 years duration, but 90% of this cohort were positive on WOQ 9.

Conclusion: A high proportion of patients appear to have wearing off on WOQ-9, but patients’ self-awareness of wearing off symptoms appears to be limited. Wearing off seems prevalent in early-phase disease. Addressing this gap could facilitate earlier therapeutic optimisation, reduce avoidable symptom burden, and improve functional outcomes for patients.

However, multiple confounding factors appear to impact the results of the WOQ-9 tool. This needs further study.

References: 1. Colosimo C, De Michele M. Motor fluctuations in Parkinson’s disease: pathophysiology and treatment. Eur J Neurol. 1999;6(1):1–21. doi: 10.1046/j.1468-1331.1999.610001.x
2. Bravi D, Mouradian MM, Roberts JW, Davis TL, Sohn YH, Chase TN. Wearing-off fluctuations in Parkinson’s disease: contribution of postsynaptic mechanisms. Ann Neurol. 1994;36(1):27–31. doi: 10.1002/ana.410360108
3. Stacy M, Hauser R, Oertel W, Schapira A, Sethi K, Stocchi F, et al. End-of-dose in Parkinson disease: a 9-question survey assessment. Clin Neuropharmacol. 2006;29(6):312–21. doi: 10.1097/01.WNF.0000232277.68501.08

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MDS Abstracts - https://www.mdsabstracts.org/abstract/are-we-overlooking-wearing-off-evaluating-the-role-of-the-woq-9-questionnaire-in-routine-parkinsons-care/