Adherence to Pharmacotherapy in Patients With Parkinson's Disease Taking Three and More Daily Doses of Medication

Abstract

Background: Once-daily treatment formulation is associated with better adherence in comparison to more complex medication regimens. The study aimed to detect the extent of adherence to pharmacotherapy in Parkinson disease (PD) patients who take a minimum of three daily doses of drugs, and to identify factors associated with lower levels of adherence. Methods: The cohort was selected from non-demented PD patients. The 8-Item Morisky Medication Adherence Scale (MMAS-8), 8-Item Parkinson's Disease Questionnaire (PDQ-8), Geriatric Depression Scale (GDS), Non-Motor Symptom Assessment Scale (NMSS), 9-Item Wearing-off Questionnaire (WOQ-9), MDS-UPDRS III (motor examination), and IV (motor complications) scales were used in this study. Results: From a total of 124 subjects, 33.9% reported a high level of adherence, 29.8% reported a medium level of adherence, and 36.3% reported a low level of adherence to their pharmacotherapy. The level of non-adherence correlated with gender, longer disease duration, higher scores of PDQ-8, NMSS, WOQ-9, and MDS-UPDRS IV. Detailed analysis of NMSS demonstrated a correlation between the level of adherence and domains sleep/fatigue, mood/cognition, perceptual problems/hallucinations, attention/memory, and urinary symptoms. Independent risk factors for non-adherence were excessive daytime sleepiness, anhedonia, and forgetfulness. Conclusion: Non-adherence to more complicated medication regimens is frequent in PD patients and is associated with gender, longer PD duration, poorer quality of life, frequency and severity of non-motor symptoms, and more severe motor and non-motor fluctuations. Non-adherence was predicted by non-motor symptoms including fatigue, mood disturbances, and subjective cognitive complaints.

Self-Reported Nonadherence to Medication Is Not Associated with Health-Related Quality of Life in Parkinson’s Disease

“…However, total adherence to therapy had a significant negative association with both the Unified Parkinson’s Disease Rating Scale (UPDRS) III score and the PDQ-39 mobility domain [ 5 ]. In another study of 124 PD subjects, the 8-Item Morisky Medication Adherence Scale (a common self-report adherence questionnaire) correlated weakly with the PDQ-8 summary index; however, this significant correlation did not survive correction for other clinical variables in stepwise multiple regression [ 6 ]. A major limitation of these three studies is that patients with cognitive impairment were not considered.…”

Association Between Nonmotor Symptoms and Nonadherence to Medication in Parkinson's Disease

“…This study aimed to replicate the association between nonadherence and NMS in PD, which was recently demonstrated by Straka et al (18). We discuss some methodological aspects .3% a low level of adherence.…”

“…Several epidemiological and clinical factors were found to be associated with nonadherence to medication in PD, such as younger age, education level, marital status, depression and anxiety, poor cognition, longer disease duration, and regimen complexity (3,4,6,(10)(11)(12)(13)(14)(15)(16)(17). Recently, Straka et al studied the relationship between NMS and adherence in 124 subjects with PD recruited from movement disorder outpatient departments of university hospitals in Slovakia (18). Here, adherence scores [eight-item Morisky medication adherence scale (MMAS-8)] positively correlated with disease duration, health-related QoL, depression, frequency, and severity of NMS [NMS scale (NMSS)], and motor and nonmotor complications.…”

Measuring Medication Adherence in Parkinson's Disease: A Systematic Review of Contributing Components in Rating Scales

“…Of the 16 selected studies, 9 evaluated medication adherence after implementation of a medication adherence therapy, [13][14][15][16][17][18][19][20][21] and 5 evaluated the natural history of medication adherence in patients with PD. [22][23][24][25][26] The 2 remaining studies presented either the development and validation of a scale designed to measure the beliefs of patients with PD related to medication 27 or to culturally validate the Morisky Medication Adherence Scales (MMAS-8) for Italian patients with PD. 28 The main concepts used to define medication adherence varied among studies and were implicitly or explicitly described as the patient behavior in relation to the prescription, 16,22,23,25 the relationship between multifactorial aspects that impact in various domains of life, 15,17,18,28 the relationship between intentional and nonintentional factors, 13,14,24 how often the patient engages in 5 aspects of adherence behavior, 20 the relationship between factors including positive beliefs about medication, 27 26 and the domain measured by a scale 19 ( Table 2).…”