Objective: To identify key clinical indicators for Parkinson disease (PD) patients inadequately controlled with oral medications or eligible for device-aided treatments.

Background: Identifying patients with advancing symptoms and optimizing therapy earlier in PD course are areas for clinical practice improvement.

Methods: A cross-sectional web survey was sent to 19 Movement Disorder Specialists (MDS) from the EU and US to rate the clinical relevance and importance of 10 motor symptoms (MS), 8 non-motor symptoms (NMS), and 6 functional impacts (FI) identified through a 2015 Delphi consensus study. The survey assessed indicators for PD patients inadequately controlled on oral PD medications and/or eligible for device-aided treatment (DAT).

Results: 16 MDS with >20 years of PD clinical experience completed the survey. Troublesome MS fluctuation received the highest ranking as an indicator of inadequate control on oral medications, followed by ≥2 hours of “off” time/day, MS complications, NMS fluctuations, troublesome hallucinations/psychosis, ≥1 ADL limitations, and increased falls. Indicators considered most clinically sensitive to oral medication optimization were MS complications, ≥1 hour/ day with troublesome dyskinesias, impulse control disorders, and troublesome hallucinations/psychoses. Agreement between MDS for importance ranking of MS, NMS and FI indicators of inadequate control on oral medications was 0.70, 0.26, and 0.17, respectively. The highest ranked indicators for device-aided treatment were troublesome level of MS fluctuations, ≥2 hours of “off” time/day, NMS fluctuations, ≥1 ADL limitations. The highest rated indicators expected to improve with DAT were troublesome MS fluctuations, MS complications, and NMS fluctuations. Agreement on importance rankings of MS, NMS and FI indicators for DAT was 0.70, 0.55, and 0.30, respectively.

Conclusions: Troublesome MS, NMS fluctuations and ADL limitations were indicators of inadequate control on oral medications, but were not considered manageable through oral medication optimization. MS and NMS fluctuations are important indicators of eligibility and were considered manageable by DAT. In the next steps low inter-rater reliability for NMS and FI items will be explored. A pilot clinician screening tool will be developed and tested using patient vignettes and validated with general neurologists and MDS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/development-of-a-clinician-reported-screening-tool-to-identify-patients-with-parkinsons-disease-inadequately-controlled-on-oral-medications/