Objective: To prospectively investigate the frequency and determinants of wearing-off (WO) in Parkinson’s disease (PD) using a validated patient-reported instrument compared to routine neurological evaluation, and to quantify the differential impact of motor and non-motor WO symptoms on quality of life (QoL).

Background: Wearing-off phenomena represent a major source of disability in PD, yet non-motor fluctuations and early-stage WO remain systematically underrecognized in clinical practice despite their therapeutic implications.

Method: This single-center observational cross-sectional study enrolled 117 consecutive ambulatory PD patients receiving dopaminergic therapy for ≥1 year. All participants underwent standardized neurological evaluation for WO followed by self-administration of the Wearing-Off Questionnaire 19 (WOQ-19; positivity ≥2). QoL was assessed using the Parkinson’s Disease Questionnaire 8 (PDQ-8). Demographic, clinical, and therapeutic variables, including UPDRS scores and levodopa treatment duration, were systematically collected. Multivariate logistic regression analysis identified independent determinants of WO.

Results: The mean disease duration was 5.8±3.5 years, and 98.1% received levodopa. Neurologists identified WO in 65 patients (55.6%); conversely, WOQ-19 identified WO in 75 patients (64.1%), demonstrating a 15.4% relative increase in detection (p<0.05). In the early disease subgroup (≤3 years), this discrepancy was markedly greater: neurologists identified 6 patients, whereas WOQ-19 detected 13 (116.7% relative increase). The predominant symptom was “slowness of movements” (55.8%). Logistic regression revealed significant independent associations between WO and male gender, higher MDS-UPDRS Part II scores, and prolonged levodopa exposure (p<0.05 for all). Critically, higher burden of both motor and non-motor WO symptoms correlated strongly with poorer QoL (both p<0.0001).

Conclusion: This study demonstrates that WO is substantially underestimated by routine clinical evaluation, particularly during early disease stages and when non-motor manifestations are considered. The significant discordance between clinician assessment and patient-reported outcomes, coupled with robust evidence of impaired QoL, mandates implementation of systematic WO screening in standard PD care to facilitate timely, personalized therapeutic interventions.

References: D.Bose, A.Mukherjee, M.Acharya, S.Choudhury, and N.Ghosh, “Artificial Intelligence for Detection of Parkinson’s Disease From Speech Signals—A Comprehensive Review,” BioFactors51, no. 6 (2025): e70065, https://doi.org/10.1002/biof.70065.

Acharya, Mrinal; Banerjee, Subhadeep; Chatterjee, Apratim; Mukherjee, Adreesh; Biswas, Samar; Gangopadhyay, Goutam; Biswas, Atanu. Predicting Long-Term Outcome of Patients of Early Parkinsonism with Acute Levodopa Challenge Test. Neurology India 69(2):p 430-434, Mar–Apr 2021. | DOI: 10.4103/0028-3886.314539

Treatment Reconciliation in Parkinson’s Disease Patients with Particular Reference to Wearing-off and Motor fluctuations: A Registry-based, Prospective, Observational Study.
S SAHOO, A PAL, SM NASER, C BAGCHI, S MUNSHI, SK TRIPATHI, …
Journal of Clinical & Diagnostic Research 17 (6)

Acharya, M. (2024, September). Decoding non-IParkinson’s disease (PD) Parkinsonism-A Comparative Analysis of Atypical and Secondary Parkinsonism. In MOVEMENT DISORDERS (Vol. 39, pp. S32-S33). 111 RIVER ST, HOBOKEN 07030-5774, NJ USA: WILEY.

Antiparkinson’s Drug-Effects On Quality Of Life And Safety Among Parkinson Disease Patients-A Prospective Observational Study In A Tertiary Care Hospital Of West-Bengal; S Sahoo, A Pal, SM Naser, CH Bagchi, S Munshi, M Acharya, SH Dasgupta, SK Tripathi, S Samajdar, S Sarkar; 2024; Panacea Journal Of Medical Sciences; Volume 14; Issue 2; Pages- 409-414

P. Dutta, A. Eshore, P. Guha, M. Acharya. Electrochemical Sensing for Accurate L-Dopa Detection in Parkinson’s disease [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/electrochemical-sensing-for-accurate-l-dopa-detection-in-parkinsons-disease/. Accessed March 12, 2026.

Acharya, M., Biswas, A., Ganguly, G., & Das, S. (2018, October). Utility of Acute Levodopa Challenge Test In Early Parkinsonism. In MOVEMENT DISORDERS (Vol. 33, pp. S439-S441). 111 RIVER ST, HOBOKEN 07030-5774, NJ USA: WILEY.

Mandal, R., & Acharya, M. K. (2025, May). Parkinsonism And Related Disorders 134 (2025) 107588 Parkinson’s Disease: Fear Of Fall, Slow Cadence; Efficacy Of Spinal Extensors Strengthening Exercise. In Parkinsonism & Related Disorders (Vol. 134). 125 London Wall, London, England: Elsevier Sci Ltd.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-underestimation-of-wearing-off-in-parkinsons-disease-patient-reported-outcomes-versus-clinical-assessment-and-impact-on-quality-of-life/