Predictors of motor complications in early Parkinson's disease: a prospective cohort study
The objective of this study was to identify clinical predictors of motor complications (dyskinesia and motor fluctuations) of levodopa in a prospectively recruited PD cohort using longitudinal analysis. An inception cohort (Oxford Discovery) of 734 patients was followed to a maximum of 10 years from...
| Главные авторы: | , , , , , , , , |
|---|---|
| Формат: | Journal article |
| Язык: | English |
| Опубликовано: |
Wiley
2019
|
| _version_ | 1826306549945991168 |
|---|---|
| author | Kelly, MJ Lawton, MA Baig, F Ruffmann, C Barber, TR Lo, C Klein, JC Ben-Shlomo, Y Hu, MT |
| author_facet | Kelly, MJ Lawton, MA Baig, F Ruffmann, C Barber, TR Lo, C Klein, JC Ben-Shlomo, Y Hu, MT |
| author_sort | Kelly, MJ |
| collection | OXFORD |
| description | The objective of this study was to identify clinical predictors of motor complications (dyskinesia and motor fluctuations) of levodopa in a prospectively recruited PD cohort using longitudinal analysis. An inception cohort (Oxford Discovery) of 734 patients was followed to a maximum of 10 years from diagnosis using a discrete-time survival analysis. A subset analysis was used to validate an online dyskinesia-risk calculator developed from the results of the Stalevo Reduction in Dyskinesia Evaluation PD trial. A total of 186 cases of dyskinesia and 254 cases of motor fluctuations were observed. Dyskinesia incidence increased with time (risk per 100 participants [95% confidence interval] 13 [11-16] <3.5 years, 16 [13-21] 3.5-5.0 years, 19 [14-26] 5-6.5 years, and 23 [16-33] >6.5 years from diagnosis). Motor complication predictors were grouped as medication predictors, disease predictors and patient predictors. Baseline nonmotor feature severity, low mood, anxiety, and age at symptom onset were associated with motor complications among a number of previously identified predictors. Replication of the Stalevo Reduction in Dyskinesia Evaluation PD calculator was reasonable with the area under the curve for dyskinesia risk score as a predictor of dyskinesia being 0.68 (95% confidence interval, 0.55-0.81). This study quantifies risk of motor complications, finds consistent predictors, and demonstrates the novel finding that nonmotor features of PD, particularly low mood and anxiety, are significant risk factors for motor complications. Further validation of dyskinesia risk scores are required as well as evidence to determine if the routine use of such scores can be clinically valuable in enhancing patient care and quality of life. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society. |
| first_indexed | 2024-03-07T06:49:38Z |
| format | Journal article |
| id | oxford-uuid:fc163ef0-00fe-470f-b445-29c94b54521e |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T06:49:38Z |
| publishDate | 2019 |
| publisher | Wiley |
| record_format | dspace |
| spelling | oxford-uuid:fc163ef0-00fe-470f-b445-29c94b54521e2022-03-27T13:18:25ZPredictors of motor complications in early Parkinson's disease: a prospective cohort studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:fc163ef0-00fe-470f-b445-29c94b54521eEnglishSymplectic Elements at OxfordWiley2019Kelly, MJLawton, MABaig, FRuffmann, CBarber, TRLo, CKlein, JCBen-Shlomo, YHu, MTThe objective of this study was to identify clinical predictors of motor complications (dyskinesia and motor fluctuations) of levodopa in a prospectively recruited PD cohort using longitudinal analysis. An inception cohort (Oxford Discovery) of 734 patients was followed to a maximum of 10 years from diagnosis using a discrete-time survival analysis. A subset analysis was used to validate an online dyskinesia-risk calculator developed from the results of the Stalevo Reduction in Dyskinesia Evaluation PD trial. A total of 186 cases of dyskinesia and 254 cases of motor fluctuations were observed. Dyskinesia incidence increased with time (risk per 100 participants [95% confidence interval] 13 [11-16] <3.5 years, 16 [13-21] 3.5-5.0 years, 19 [14-26] 5-6.5 years, and 23 [16-33] >6.5 years from diagnosis). Motor complication predictors were grouped as medication predictors, disease predictors and patient predictors. Baseline nonmotor feature severity, low mood, anxiety, and age at symptom onset were associated with motor complications among a number of previously identified predictors. Replication of the Stalevo Reduction in Dyskinesia Evaluation PD calculator was reasonable with the area under the curve for dyskinesia risk score as a predictor of dyskinesia being 0.68 (95% confidence interval, 0.55-0.81). This study quantifies risk of motor complications, finds consistent predictors, and demonstrates the novel finding that nonmotor features of PD, particularly low mood and anxiety, are significant risk factors for motor complications. Further validation of dyskinesia risk scores are required as well as evidence to determine if the routine use of such scores can be clinically valuable in enhancing patient care and quality of life. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society. |
| spellingShingle | Kelly, MJ Lawton, MA Baig, F Ruffmann, C Barber, TR Lo, C Klein, JC Ben-Shlomo, Y Hu, MT Predictors of motor complications in early Parkinson's disease: a prospective cohort study |
| title | Predictors of motor complications in early Parkinson's disease: a prospective cohort study |
| title_full | Predictors of motor complications in early Parkinson's disease: a prospective cohort study |
| title_fullStr | Predictors of motor complications in early Parkinson's disease: a prospective cohort study |
| title_full_unstemmed | Predictors of motor complications in early Parkinson's disease: a prospective cohort study |
| title_short | Predictors of motor complications in early Parkinson's disease: a prospective cohort study |
| title_sort | predictors of motor complications in early parkinson s disease a prospective cohort study |
| work_keys_str_mv | AT kellymj predictorsofmotorcomplicationsinearlyparkinsonsdiseaseaprospectivecohortstudy AT lawtonma predictorsofmotorcomplicationsinearlyparkinsonsdiseaseaprospectivecohortstudy AT baigf predictorsofmotorcomplicationsinearlyparkinsonsdiseaseaprospectivecohortstudy AT ruffmannc predictorsofmotorcomplicationsinearlyparkinsonsdiseaseaprospectivecohortstudy AT barbertr predictorsofmotorcomplicationsinearlyparkinsonsdiseaseaprospectivecohortstudy AT loc predictorsofmotorcomplicationsinearlyparkinsonsdiseaseaprospectivecohortstudy AT kleinjc predictorsofmotorcomplicationsinearlyparkinsonsdiseaseaprospectivecohortstudy AT benshlomoy predictorsofmotorcomplicationsinearlyparkinsonsdiseaseaprospectivecohortstudy AT humt predictorsofmotorcomplicationsinearlyparkinsonsdiseaseaprospectivecohortstudy |