Session Information
Date: Thursday, June 8, 2017
Session Title: Clinical Trials and Therapy in Movement Disorders
Session Time: 1:15pm-2:45pm
Location: Exhibit Hall C
Objective: To define variation in L-dopa response in recent onset PD.
Background: L-Dopa responsiveness is a defining feature of Parkinson’s disease (PD), but the degree of L-Dopa response varies between patients. Factors contributing to this variation merit exploration.
Methods: Patients in Tracking Parkinson’s, a natural history study in the United Kingdom, were scored on the MDS Unified PD Rating Scale motor scale (UPDRS3), before and 1 hour after their usual morning dose of L-Dopa, after a practically defined overnight period off anti-parkinsonian medication. A positive response was recorded when the improvement in UPDRS 3 was over 30%. A history of vascular disease (cardiac/cerebral) was noted. In those without a history of vascular disease, future risk for vascular events was determined using the QRISK2 score which combines age, sex, and disease comorbidity factors.
Results: In 996 cases aged 67.4 years (SD 9.1 years) at diagnosis, L-dopa response was tested at 3.3 years’ (SD 0.9) disease duration. A positive L-dopa response was seen in 510 cases (51.2%). Those who showed a positive L-Dopa response were younger (65.9 years, SD 9.5) compared to poor responders (69.1 years, SD 8.4, p<0.001), had a lower UPDRS 3 score (20.5, SD 10.0) versus 24.3 (SD 13.1) in poor responders, and showed a lower increment in UPDRS 3 scores over the preceding 18 months (2.8 points, SD 10.7) compared to poor responders (increase of 6.0 points, SD 10.6, p<0.001). Only 38.2% of the 89 patients with Type 2 diabetes showed a positive L-Dopa response. In patients with a prior history of vascular disease (n=147) only 44.9% showed a positive L-dopa response. Similarly, in patients with a high vascular risk score (n=344), only 44.5% responded to L-dopa, compared to 53.3% at medium vascular risk score (n=287), and 63.1% at low vascular risk score (n=214).
Conclusions: Reduced L-dopa responsiveness is seen in PD patients with vascular comorbidity, and with increased vascular risk factors. This has implications for diagnosis and patient management.
To cite this abstract in AMA style:
N. Malek, M. Lawton, K. Grosset, N. Bajaj, R. Barker, Y. Ben-Shlomo, D. Burn, T. Foltynie, J. Hardy, H. Morris, N. Williams, N. Wood, D. Grosset. Levodopa responsiveness in Parkinson’s disease is significantly impaired in those with diabetes and increased vascular risk. [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/levodopa-responsiveness-in-parkinsons-disease-is-significantly-impaired-in-those-with-diabetes-and-increased-vascular-risk/. Accessed June 15, 2025.« Back to 2017 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/levodopa-responsiveness-in-parkinsons-disease-is-significantly-impaired-in-those-with-diabetes-and-increased-vascular-risk/