Remnants of Cardinal Symptoms of Parkinson’s Disease, Not Dyskinesia, Are Problematic for Dyskinetic Patients Performing Activities of Daily Living.
Front. Neurol.. 2019-03-22; 10:
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1. Front Neurol. 2019 Mar 22;10:256. doi: 10.3389/fneur.2019.00256. eCollection
Remnants of Cardinal Symptoms of Parkinson’s Disease, Not Dyskinesia, Are
Problematic for Dyskinetic Patients Performing Activities of Daily Living.
Goubault E(1)(2), Nguyen HP(1)(2), Bogard S(1)(2), Blanchet PJ(3)(4), Bézard
E(5)(6), Vincent C(7), Sarna J(8), Monchi O(8), Duval C(1)(2).
(1)Département des Sciences de l’Activité Physique, Université du Québec à
Montréal, Montréal, QC, Canada.
(2)Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal,
Montréal, QC, Canada.
(3)Département de Stomatologie, Faculté de Médecine Dentaire, Université de
Montréal, Montréal, QC, Canada.
(4)Département de Médecine, CHU Montréal, Montréal, QC, Canada.
(5)Laboratoire de Neurophysiologie, Université de Bordeaux, Institut des Maladies
Neurodégénératives, Bordeaux, France.
(6)Unité Mixte de Recherche 5293, Centre National de la Recherche Scientifique,
Institut des Maladies Neurodégénératives, Bordeaux, France.
(7)Département de Réadaptation, Faculté de Médecine, Université Laval, Quebec,
(8)Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of
Calgary, Calgary, AB, Canada.
Introduction: The impact of levodopa-induced dyskinesia (LID) on the daily lives
of patients with Parkinson’s disease (PD) remains to be determined. Furthermore,
evidence suggests that cardinal motor symptoms of PD may coexist with LID, but
their impact on activities of daily living (ADL) relative to LID is not known.
This cross-sectional study aimed at determining the effect of LID and cardinal
motor symptoms of PD on ADL in patients who were experiencing peak-dose
choreic-type LID. Method: One hundred and twenty-one patients diagnosed with PD
known to experience choreic-type LID were recruited for the study. Patients were
asked to perform a set of ADL. Levels of LID, tremor, bradykinesia, and freezing
of gait (FoG) were measured using 17 inertial sensors design to capture full body
movements, while rigidity, and postural instability were assessed using clinical
evaluations. Cognition was also assessed using the mini-mental state examination.
Success criteria were set for each ADL using the time needed to perform the task
and errors measured in 69 age-gender-matched healthy controls. Binary logistic
regressions were used to identify symptoms influencing success or failure for
each activity. Receiver operating characteristic curves were computed on each
significant symptom, and Youden indexes were calculated to determine the critical
level of symptomatology at which the performance significantly changed. Results:
Results show that 97.7% of patients who presented with LID during the experiment
also presented with at least one cardinal motor symptom. On average, patients
took more time and did more errors during ADL. Multivariate analyses revealed
that for the great majority of ADL, LID were not associated with worsening of
performance; however, postural instability, tremor, rigidity, and cognitive
decline significantly decreased the odds of success. Conclusions: Residual
symptoms of PD, such as tremor, rigidity, and postural instability still present
at peak-dose were more problematic than LID in the performance of ADL for
patients experiencing slight-to-moderate LID. We also found that cognitive
decline was associated with decreased performance in certain tasks. Therefore, a
strategy using lower doses of medication to manage LID may be counterproductive
since it would not address most of these symptoms already present in patients.