Objective: To explore the association between prediagnostic symptoms and treatment initiation in people with Parkinson´s disease (PD)

Background: Prediagnostic symptoms in people with PD may influence time to initiation of PD treatment and the choice of first treatment class, but limited data exist.

Method: This retrospective cohort study used data from UK primary care medical records within the Clinical Practice Research Datalink (CPRD) from 2007-2018. We identified people with a first record of PD diagnosis in the study period. Treatments of interest were levodopa and levodopa combination therapies (LD), dopamine agonists (DA) and monoamine oxidase B inhibitors (MAO-Bi). Twenty-one PD symptoms and their corresponding READ-codes were retrieved from a previously published study [1]. Presence of these symptoms within 12 months before first PD diagnosis was summarized. Cox proportional hazards analysis was used to evaluate the age and sex-adjusted association of each symptom with the occurrence of the initiation of PD treatment overall and per treatment class.

Results: The study cohort comprised 6,314 people with incident PD (38.5% women; mean (SD) age: 72.7 (10.2); mean (SD) follow-up time: 4.1 (2.5) years). The majority (79.1%) of people with PD initiated treatment at any time during the follow-up period; LD was the first-line therapy for most (72.3%), followed by DA (17.2%) and MAO-Bi (10.1%). The most frequent prediagnostic symptoms were tremor (34.9%), depression (6.9%), constipation (6.8%), anxiety (5.6%) and dizziness (5.4%). Symptoms associated with initiation of any PD treatment were fatigue (HR 1.28 (95% CI 1.14-1.44)), anxiety (HR 1.17 (95% CI 1.04-1.32) and tremor (HR 1.10 (95% CI 1.03-1.16)). Symptoms associated with LD initiation were rigidity (HR 1.41 (95% CI 1.12-1.78)), fatigue (HR 1.23 (95% CI 1.09-1.40)), constipation (HR 1.20 (95% CI 1.07-1.34)) and anxiety (HR 1.18 (95% CI 1.04-1.33)). Tremor was associated with the initiation of DA (HR 1.20 (95% CI 1.09-1.33) and MAO-Bi (HR 1.39 (95% CI 1.23-1.57)).

Conclusion: People with rigidity, fatigue, constipation or anxiety before the PD diagnosis were more likely to initiate LD treatment compared to those without these symptoms. Tremor was the most common prediagnostic symptom and was associated with the initiation of DA and MAO-Bi.

References: [1] Schrag A, Horsfall L, Walters K, Noyce A, Petersen I. Prediagnostic presentations of Parkinson’s disease in primary care: a case‐control study. Lancet Neurol 2015;14:57–64.

« Back to MDS Virtual Congress 2020

MDS Abstracts - https://www.mdsabstracts.org/abstract/association-between-prediagnostic-symptoms-and-patterns-of-treatment-initiation-in-people-with-parkinsons-disease-in-the-united-kingdom/