Safety and Tolerability of Pharmacotherapies for Parkinson’s Disease in Geriatric Patients

Klietz, Martin; Greten, Stephan; Wegner, Florian; Höglinger, Günter U.

doi:10.1007/s40266-019-00654-z

Cited by 45 publications

(82 citation statements)

References 249 publications

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“…Since patients were free to decide to participate in our study, we cannot exclude a selection bias including more motivated patients and their caregivers. While we did not evaluate patients' medication and comorbidities in our study, we only included patients without severe comorbidities [52].…”

Section: Limitationsmentioning

confidence: 99%

Association of Motor and Cognitive Symptoms with Health-Related Quality of Life and Caregiver Burden in a German Cohort of Advanced Parkinson’s Disease Patients

Klietz

Schnur

Drexel

et al. 2020

Parkinson's Disease

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Parkinson’s disease (PD) is a chronic progressive movement disorder with severe reduction in patients’ health-related quality of life (HR-QoL). Motor and cognitive symptoms are especially linked with decreased PD patients’ HR-QoL. However, the relationship of these symptoms to caregiver burden is relatively unclear. Influence of the Montreal Cognitive Assessment scale (MoCA) as a cognitive screening tool and Movement Disorders Society Unified Parkinson’s disease Rating Scale MDS-UPDRS symptoms in relation to patients’ HR-QoL and caregivers` burden was analyzed. PD patients (n = 124) completed MDS-UPDRS, MoCA, and the PD questionnaire 8 (PDQ-8) as a measure of quality of life. Caregivers (n = 78) were assessed by the PD caregiver burden inventory (PDCB). PDQ-8 and PDCB scores were regressed on MDS-UPDRS subscales and MoCA subscores. PDQ-8 correlated with attention (R2 0.1282; p<0.001) and executive (R2 0.0882; p 0.001) MoCA subscores and all parts of the MDS-UPDRS. PDCB correlated most strongly with MDS-UPDRS part III motor symptoms (R2 0.2070; p<0.001) and the MoCA attention subscore (R2 0.1815; p<0.001). While all facets of PD symptoms assessed by the MDS-UPDRS relate to PD patients’ quality of life, motor symptoms are the most relevant factor for the prediction of caregiver burden. In addition, patients’ attentional symptoms seem to affect not only them, but also their caregivers. These findings show the potential of a detailed analysis of MDS-UPDRS and MoCA performance in PD patients.

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Section: Limitationsmentioning

confidence: 99%

Association of Motor and Cognitive Symptoms with Health-Related Quality of Life and Caregiver Burden in a German Cohort of Advanced Parkinson’s Disease Patients

Klietz

Schnur

Drexel

et al. 2020

Parkinson's Disease

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“…When new drugs are available for the management of PD, it is important to consider the disease symptoms that can be better controlled, the complications that can be diminished by its use, and the potential adverse events and drug interactions that may have a negative impact in the disease. Patients with PD are particularly at risk of adverse drug events since they are typically treated by polypharmacy (i.e., five or more different types of medication) [45]. Polypharmacotherapy includes significant risks as a result of potential interactions between antiparkinsonian drugs and other CNS-active or QT-prolonging drugs [46].…”

Section: Discussionmentioning

confidence: 99%

A Spanish Consensus on the Use of Safinamide for Parkinson’s Disease in Clinical Practice

et al. 2020

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Safinamide is an approved drug for the treatment of motor fluctuations in Parkinson’s disease (PD). Scarce data are available on its use in clinical practice. A group of Spanish movement disorders specialists was convened to review the use of safinamide across different clinical scenarios that may guide neurologists in clinical practice. Eight specialists with recognized expertise in PD management elaborated the statements based on available evidence in the literature and on their clinical experience. The RAND/UCLA method was carried, with final conclusions accepted after a 2-round modified Delphi process. Higher level of agreement between panellists was reached for the following statements. Safinamide significantly improves mean daily OFF time without troublesome dyskinesias. Adjunctive treatment with safinamide is associated with motor improvements in patients with mid-to-late PD. The efficacy of safinamide on motor fluctuations is maintained at long-term, with no increase over time in dyskinesias severity. The clinical benefits of safinamide on pain and depression remain unclear. Safinamide presents a similar incidence of adverse events compared with placebo. The efficacy and safety of safinamide shown in the pivotal clinical trials are reproduced in clinical practice, with improvement of parkinsonian symptoms, decrease of daily OFF time, control of dyskinesias at the long term, and good tolerability and safety.

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“…Recommendations referring to therapy with dopaminergic medication at the end-of-life were classified as relevant by the experts in the Delphi study. Dopaminergic therapy is a major factor for the alleviation of bothersome motor symptoms such as rigor or tremor and discontinuation may even lead to akinetic crises in the end-of-life care of PwP [23]. In case of non-oral advanced therapies, the patient should be informed in advance of the additive palliative care value of an intervention.…”

Section: Discussionmentioning

confidence: 99%

“…However, drug safety related recommendations were not consented in the panel, highlighting the difficulty of generalizing the complex and individual decisions concerning medication and treatment goals. As many of these patients were in an geriatric age, multimorbid and under polypharmacotherapy [23]. Comments from the panel state that decisions on medication should be in the hands of the attending physician, as they have the necessary specialist knowledge.…”

Section: Discussionmentioning

confidence: 99%

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Consensus-Based Recommendations for Advance Directives of People with Parkinson’s Disease in Regard to Typical Complications by German Movement Disorder Specialists

Klietz

Berndt

Wegner

et al. 2020

JCM

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A huge proportion of people with Parkinson’s disease (PwP) in Germany have written an advance directive (AD). However, the content of these forms in regard to specific Parkinson’s disease (PD)-related complications is rather low. There is an urgent need to specify ADs of PwP and consequently to improve decision-making concerning end-of-life aspects for affected patients. Evidence- and consensus-based PD-specific recommendations for ADs might help to close this gap. A Delphi study with two online Delphi rounds was initiated. Initial recommendations were built on findings from previous studies and derived from evidence-based literature. Consensus on recommendations was defined as ≥80% concordance regarding clarity of formulated aspects and relevance for clinical practice. A total of 22 experts (15.2% response rate) predominantly from the workgroup ‘neuro-palliative care’ in Germany performed two Delphi rounds. Consensus was achieved for 14 of 24 initially presented recommendations. Recommendations relating to dopaminergic therapy as well as to non-oral therapy options were considered important by the expert panel. The recommendations should be taken into account when developing and giving advice on ADs for PwP. Health professionals should be trained in counselling ADs of PwP and in integrating these recommendations in ADs during the disease course of PD.

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Safety and Tolerability of Pharmacotherapies for Parkinson’s Disease in Geriatric Patients

Cited by 45 publications

References 249 publications

Association of Motor and Cognitive Symptoms with Health-Related Quality of Life and Caregiver Burden in a German Cohort of Advanced Parkinson’s Disease Patients

Association of Motor and Cognitive Symptoms with Health-Related Quality of Life and Caregiver Burden in a German Cohort of Advanced Parkinson’s Disease Patients

A Spanish Consensus on the Use of Safinamide for Parkinson’s Disease in Clinical Practice

Consensus-Based Recommendations for Advance Directives of People with Parkinson’s Disease in Regard to Typical Complications by German Movement Disorder Specialists

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