Objective: To assess responsiveness of non-motor symptoms (NMS) to Levodopa (L-dopa) and to describe the NMS burden in late stage Parkinson’s disease (PD). Moreover, to investigate relationships between L-dopa effect on NMS and on motor function.

Background: PD is not only a movement disorder, but a disease that involves a large number of NMS as well. NMS are common in late stage PD, as the frequency and severity of most of these symptoms increase with advancing disease.

Methods: Thirty PD patients, 18 (60%) men, median age 83 years, median PD duration 12 years, in Hoehn and Yahr stages IV (n=19) and V (n=11) in “on” were included. The median (q1-q3) L-dopa equivalent daily dose (LEDD) was 774 (519-925) mg. Exclusion criteria: cognitive symptoms that started before the PD diagnosis, a score of <15 on Mini Mental State Examination (MMSE). Non-motor symptomatology was assessed by the Non-Motor Symptoms Scale (NMSS; 0-360) and the modified version of the NMSS in the “off” and “on” states during a standardized L-dopa test.

Results: NMS are common in late stage PD and many of the symptoms occur in >80% of the individuals. The median (q1-q3) total NMSS score during baseline assessment was 94 (56-111). NMSS domain D3: Mood/apathy was the area with the most pronounced symptoms as well as where the greatest L-dopa effect was observed. The highest NMSS scores were seen within the domains D3: Mood/apathy and D7: Urinary in both the “off” and the “on” states. There were statistically significant differences between the “off” and the “on” states for domains D2: Sleep/fatigue, D3: Mood/apathy, D5: Attention/memory, D6: Gastrointestinal and D7: Urinary. The differences in the NMSS score between the “off” and the “on” states were in general larger for motor responders (≥15% improvement on the UPDRS III score during L-dopa test) than for motor non-responders (<15% improvement on the UPDRS III score during L-dopa test). In motor non-responders, differences of the NMSS score between the “off” and “on” states were observed for the total score, domain D3: Mood/apathy and its item 11-Flat moods.

Conclusions: There is an L-dopa effect on NMS in late stage PD with pronounced effects particularly on mood/apathy, to some extent also for those with a non-significant response on motor function during L-dopa test. It is therefore of importance to optimize dopaminergic therapy in order to give the most effective symptomatic treatment possible.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-effect-on-non-motor-symptoms-in-late-stage-parkinsons-disease/