Drug adherence in patient group with Parkinson's disease

Background Patients with Parkinson’s disease needs medicines administered frequently to manage their condition and maintain their quality of life. Poor medicine adherence may influence health negatively, and cause an unnecessary medicine wastage. It is therefore important that they are effectively supported to ensure that they adhere to their medicine regime. The aim of the study is to identify barriers to medicine adherence in patients with Parkinson’s disease or Parkinsonism and to identify interventions to improve medicine adherence. Method A postal questionnaire containing 39 statements was sent to 430 patients. The statements were used to identify patient barriers to adherence. A focus group consisting of healthcare professionals discussed interventions to improve medicine adherence. Results 229 (53,3%) patients responded to the questionnaire. The main barriers to adherence are; having enough time with doctor and pharmacist; being requested to attend to follow-up sessions; knowing where to get help if needed; having the ability to solve problems appearing when taking medicines; worry about side-effects; feeling that taking medicines is a burden and knowing enough about their medicines to decide whether to take them. Disease length did not relate to the responded barriers to non-adherence. Motivation- intention and ability to remember- to take medicines are important barriers to non-adherence. Conclusion There are several barriers to medicine adherence in the study population, indicating there is a need for interventions from healthcare professionals to improve adherence and increase the health of this patient group.Masteroppgave i FarmasiFARM399/05HMATF-FAR

Parkinson's Disease with Device, Diary, or in Disguise. Dyskinesia reduction, motor state evaluation, and workforce participation among persons with Parkinson's disease.

INTRODUCTION: In the wait for disease-modifying treatment for Parkinson’s disease (PD), efforts towards improved symptom control and reduced negative effects of PD can result in meaningful change patients. The general efficacy of levodopa-carbidopa intestinal gel (LCIG) in advanced PD has been established, but its effects on dyskinesia need more investigation. The PD Home Diary has been used in clinical trials to evaluate treatment effects for almost 20 years, but needs to be validated. As treatments improve, it is vital to understand how PD affects workforce participation to further reduce the personal and societal effects of PD.AIMS: The overarching aim of this thesis is to increase the knowledge on how health services can support persons with PD. The thesis has two main themes: motor fluctuations and workforce participation. Firstly, the aim was to contribute to a better understanding and utilization of existing tools in the treatment and evaluation of motor fluctuations in PD: LCIG and the PD Home Diary. Secondly, the aim was to improve our understanding of the impact of PD on workforce participation.METHODS: Two clinical observational studies were used to investigate the effects of LCIG on dyskinesia and to validate the PD Home Diary, while one cross-sectional and one longitudinal registry study was designed to investigate workforce participation among persons with PD.RESULTS: LCIG was found to reduce dyskinesia among persons with advanced PD and troublesome dyskinesia at baseline. Motor state assessments from the patient-reported PD Home Diary and those by an experienced observer were found to be in fair agreement. Workforce unavailability was found to be associated with anxiety among working-age persons with PD. Persons with a first sick-leave due to PD exhibited increased sickness absence in the preceding five-year period compared to controls, particularly due to musculoskeletal diagnoses.CONCLUSIONS AND IMPLICATIONS: LCIG is a feasible treatment also for persons with advanced PD and troublesome dyskinesia. The PD Home Diary should not be regarded as interchangeable with the observer assessment gold standard. The association between workforce unavailability and anxiety needs further investigation, but anxiety should nonetheless be treated when identified. Musculoskeletal sickness absence is significantly increased in prodromal and early PD, which emphasizes that functioning and workforce participation is likely to be affected already at the time of diagnosis and thus demands immediate attention

A Stage-Based Approach to Therapy in Parkinson's Disease.

Parkinson's disease (PD) is a neurodegenerative disorder that features progressive, disabling motor symptoms, such as bradykinesia, rigidity, and resting tremor. Nevertheless, some non-motor symptoms, including depression, REM sleep behavior disorder, and olfactive impairment, are even earlier features of PD. At later stages, apathy, impulse control disorder, neuropsychiatric disturbances, and cognitive impairment can present, and they often become a heavy burden for both patients and caregivers. Indeed, PD increasingly compromises activities of daily life, even though a high variability in clinical presentation can be observed among people affected. Nowadays, symptomatic drugs and non-pharmaceutical treatments represent the best therapeutic options to improve quality of life in PD patients. The aim of the present review is to provide a practical, stage-based guide to pharmacological management of both motor and non-motor symptoms of PD. Furthermore, warning about drug side effects, contraindications, as well as dosage and methods of administration, are highlighted here, to help the physician in yielding the best therapeutic strategies for each symptom and condition in patients with PD

Salivary biomarkers for the diagnosis and monitoring of neurological diseases

Current research efforts on neurological diseases are focused on identifying novel disease biomarkers to aid in diagnosis, provide accurate prognostic information and monitor disease progression. With advances in detection and quantification methods in genomics, proteomics and metabolomics, saliva has emerged as a good source of samples for detection of disease biomarkers. Obtaining a sample of saliva offers multiple advantages over the currently tested biological fluids as it is a non-invasive, painless and simple procedure that does not require expert training or harbour undesirable side effects for the patients. Here, we review the existing literature on salivary biomarkers and examine their validity in diagnosing and monitoring neurodegenerative and neuropsychiatric disorders such as autism and Alzheimer\u27s, Parkinson\u27s and Huntington\u27s disease. Based on the available research, amyloid beta peptide, tau protein, lactoferrin, alpha-synuclein, DJ-1 protein, chromogranin A, huntingtin protein, DNA methylation disruptions, and micro-RNA profiles display a reliable degree of consistency and validity as disease biomarkers

Old and new challenges in Parkinson's disease therapeutics

Parkinson's disease (PD) is a neurodegenerative disorder characterized by the degeneration of dopaminergic neurons and/or loss od neuronal projections, in several dopaminergic networks. Current treatments for idiopathic PD rely mainly on the use of pharmacologic agents to improve motor symptomatology of PD patients. Nevertheless, so far PD remains an incurable disease. Therefore, it is of utmost importance to establish new therapeutic strategies for PD treatment. Over the last 20 years, several molecular, gene and cell/stem-cell therapeutic approaches have been developed with the aim of counteracting or retarding PD progression. The scope of this review is to provide an overview of PD related therapies and major breakthroughs achieved within this field. In order to do so, this review will start by focusing on PD characterization and current treatment options covering thereafter molecular, gene and cell/stem cell-based therapies that are currently being studied in animal models of PD or have recently been tested in clinical trials. Among stem cell-based therapies, those using MSCs as possible disease modifying agents for PD therapy and, specifically, the MSCs secretome contribution to meet the clinical challenge of counteracting or retarding PD progression, will be more deeply explored.Portuguese Foundation for Science and Technology (FCT) for the PhD fellowship attributed to A.O. Pires (Reference: SFRH/BD/33900/2009) and the IF development grant to A.J. Salgado (Reference: IF/00111/2013). Project NORTE-01-0145-FEDER-000013, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER). Funded by FEDER funds, through the Competitiveness Factors Operational Programme (COMPETE), and by National funds, through the Foundation for Science and Technology (FCT), under the scope of the project POCI-01-0145-FEDER-007038info:eu-repo/semantics/publishedVersio

Therapy concordance and drug adherence in Parkinson's disease

Chapter 1 gives an overview of the relevance of studying therapy adherence in Parkinson’s disease. Chapter 2 examines drug induced neurological syndromes and considers the validity of patients’ concerns about taking prescribed medications. Chapter 3 compares different methods of assessing therapy adherence. Chapter 4 studies factors associated with sub-optimal medicine usage in 54 patients. Chapter 5 reports a study of patient perceived involvement with management decisions and an assessment of satisfaction with the movement disorder service in 107 patients. Chapter 6 explores patients’ beliefs about antiparkinson medication in 129 patients. Chapter 7 examines the effect on Parkinson’s patients of emerging data about drug side effects, specifically fibrosis due to ergot-based dopamine agonists. Chapter 8 reports on an educational intervention designed to improve Parkinson drug timing compliance. In summary, this thesis provides important new information about medicine taking in Parkinson’s disease. A fifth of PD patients take less than 80% of prescribed antiparkinson medication. Electronic monitoring is the only reliable method of accurately detecting sub-optimal medication usage. Patients who take less than 80% of prescribed medicines are more likely to be younger, have concomitant depression, be prescribed more tablets per day and have poorer quality of life. Patients are more satisfied if they are involved in management decisions and have increased intention to comply with prescribed medication if there is better communication. Poorer quality of life is associated with less intention to comply with prescribed medication. Timing of medication intake is generally irregular but can be improved by informing patients of the continuous dopaminergic theory and providing specific drug timings. Once daily drugs are taken more consistently than drugs with more frequent doses

Dementia in Parkinson’s Disease

An estimated 50% to 80% of individuals with Parkinson’s disease experience Parkinson’s disease dementia (PDD). Based on the prevalence and clinical complexity of PDD, this book provides an in-depth update on topics including epidemiology, diagnosis, and treatment. Chapters discuss non-medical therapies and examine views on end-of-life issues as well. This book is a must-read for anyone interested in PDD whether they are a patient, caregiver, or doctor

Management of rapid eye movement sleep behavior disorder in patients with Parkinson's disease

Among all of the devastating effects that Parkinson’s disease (PD) has on an individual, sleep dysfunction is one that can have a profound effect on the entire family of the patient. The most potentially destructive of these sleep syndromes being that of Rapid Eye Movement Sleep Behavior Disorder (RBD). This disorder not only causes sleep impairment to the patient, but can occasionally result in life-threatening injury to the individual or their bed partner. While this condition is manageable with medication, the current treatment of choice is a long-acting benzodiazepine, clonazepam. This drug, while effective in treating RBD, comes with a significant burden of side effects. Patients with neurodegenerative disorders, like PD, are at even higher risk of suffering the negative impacts of this treatment. One potential alternative treatment that has been considered is a supplement of exogenous melatonin, a hormone that plays a role in maintaining one’s circadian rhythm. Several small case studies have shown potential efficacy of this treatment, and with very few side effects. However, this efficacy has not yet been proven by randomized clinical trial. This proposed study will perform a double-blind randomized clinical trial of melatonin vs. placebo in a population of PD patients with RBD. Subjects will be analyzed via polysomnographic sleep study, where symptoms will be scored on the RBD Severity Scale (RBDSS) at baseline and after a treatment intervention. Statistical analysis will then ascertain whether or not a significant symptom reduction is seen following melatonin treatment, compared to a group receiving placebo. If melatonin proves to be efficacious in this patient population, this would give clinicians a new treatment option to consider to effectively manage symptoms of RBD with a much lower risk of potentially harmful side effects. Finding an effective method of managing this condition, the prevalence of which continues to rise worldwide, will have a great impact on improving the safety and quality of life of these patients