1. Improvement of life quality and non motor symptoms relief in patients with advanced Parkinson's disease. Natalia Prican Andra Oltean Doctor Jozsef Attila Szasz Doctor Viorelia Constantin Faculty of Medicine, UMPh Targu Mureş Department of Neurology II, Faculty of Medicine, UMPh Targu Mureş

2. Introduction  Parkinson’s Disease is a chronic, progressive neurologic disease that is characterised by four cardinal motor manifestations: tremor at rest, rigidity, bradykinesia and postural instability.  Although still considered a paradigmatic movement disorder, Parkinson’s disease (PD) is associated with a broad spectrum of non-motor symptoms.  Non-motor symptoms completes the clinical picture of advanced Parkinson's disease and contribute to severe disability, impaired quality of life, and shortened life expectancy.

3. The clinical diagnosis of Parkinson's disease rests on the identification of the characteristics related to dopamine deficiency that are a consequence of degeneration of the substantia nigra pars compacta. Non-dopaminergic and non-motor symptoms are sometimes present before diagnosis and almost inevitably emerge with disease progression.

4. Treatments and drugs Carbidopa-levodopa Levodopa-carbidopa intestinal gel Dopamine agonists. Deep brain stimulation MAO-B inhibitors COMT inhibitors Anticholinergics Amantadine

5. Aim The present study aims to evaluate the progress of non motor symptoms in patients with advanced Parkinson’s disease treated with Levodopa/Carbidopa intestinal gel (Duodopa) over a period of two years. The evolution of the pacients life quality was also monitored and studied.

6. Material and method We performed a retrospective study of 17 patients with advanced Parkinson’s disease, hospitalized in Neurology Clinic of Targu Mures County Hospital which were selected for treatment with Duodopa. For each patient the revised questionnaire ” Non-Motor Symptom assessment scale for Parkinson’s Disease” was applied along with a questionnaire on quality of life. Questionnaires were completed by patients at baseline, after six, twelve, eighteen months of tratement and after two years. For data analysis we used two statistical tests: Kruskal-Wallis test and Chi- squared test.

7.  The used scale for Non-motor symptoms comprises 9 domains: Cardiovascular Sleep Mood Perceptual problems Attention/Memory Gastrointestinal tract Urinary Sexual function Miscellaneous  Each symptom included in this scale was scored respecting the severity and the frequency.  For assessing the quality of life we used a questionnaire composed of eight common situations of Parkinson's disease clinical presentation.

9. M-58.9% F-41.1% Main age-65.4 years 70-79→41.1% 60-69→35.2% 50-59 →17.6% 40-49 →5.8%

10. Domain 1 Cardiovascular Kruskal-Wallis test P=0.05 Domain 2 Sleep/fatigue P=0.87

11. Domain 3 Mood/cognition P=0.26 Domain 4 Perceptual problems, hallucinations P=0.87

12. Domain 5 Attention/memory P=0.72 Domain 6 Gastrointestinal tract P=0.047

13. Domain 7 Urinary P=o.98 Domain 8 Sexual function P=0.16

14. Domain 9 Miscellaneous Pain Changes in ability to taste or smell Changes in weight Excessive sweating P=0.75

15. Improvement of life quality (1) Was it hard to move in public? P=0.29 44.3% sometimes 19% often 6.3% never 15.2% rarely 15.2% all the time Was it hard for you to get dressed? P=0.97 39.2% sometimes 16.5% often 16.5% never 11.4% rarely 16.5% all the time 0 6m 12 m 18m 24 m

16. Improvement of life quality (2) Did you have problems in your relationships with close people ? P=0.36 20.3% sometimes 3.8% often 57% never 19% rarely 0% all the time Did you feel deviated ? P=0.1 41.8% sometimes 15.2% often 22.8%never 10.1%rarely 10.1%all the time 0 6m 12 m 18m 24 m

17. Improvement of life quality (3) Did you have difficulty concentrating? P=0.824 24.1% sometimes 7.6% often 50.6% never 17.7% rarely 0% all the time Did you feel that you can not properly communicate with people ? P=0.05 34.2% sometimes 13.9% often 35.4% never 15.2% rarely 1.3% all the time 0 6m 12 m 18m 24 m

18. Improvement of life quality (4) Did you have muscular pain or spasms? P=0.83 29.1% sometimes 27.8% often 10.1% never 24.1% rarely 8.9% all the time Did you feel embarrassed because you have Parkinson's disease? P=0.2 16.5% sometimes 13.9% often 35.4% never 19% rarely 15.2% all the time 0 6m 12 m 18m 24 m

19. Conclusions: After 24 months of tratement with Duodopa intestinal gel, we noticed a significant statistical improvement of gastrointestinal symptoms. The evolution of cardiovascular symptoms during two years of treatment with Duodopa had a slightly unfavorable course, with an increase in score and a value of P at limit. There was an improvement of the score but without statistical significance, in the next areas:mood/cognition, sleep/fatigue and sexual function. Over two years of study, patients reported no impairment of relationships and no difficulty of concentrating. The situations contained in the questionnaire on quality of life did not present a statistically significant evolution.

20. Thank you!