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Changes in quality of life in people with Parkinson’s disease left untreated at diagnosis
  1. P Asimakopoulos1,
  2. R Caslake2,
  3. C E Harris2,
  4. J C Gordon2,
  5. K S M Taylor3,
  6. C Counsell2
  1. 1
    Crosshouse Hospital, Kilmarnock, UK
  2. 2
    Department of Medicine and Therapeutics, University of Aberdeen, Foresterhill, Aberdeen, UK
  3. 3
    Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
  1. Dr C Counsell, Department of Medicine and Therapeutics, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK; carl.counsell{at}abdn.ac.uk

Abstract

Background: The issue of whether to adopt a “wait and watch” strategy or to initiate drug therapy soon after diagnosis in Parkinson’s disease (PD) has been the subject of some debate. A recent observational study supported early treatment by demonstrating deterioration in self-reported health status in those left untreated, but not those who received therapy. We aimed to replicate this observation.

Methods: People with PD from a prospective incidence study underwent follow-up with yearly clinical assessment of parkinsonian impairment (Unified Parkinson’s Disease Rating Scale (UPDRS)) and self-reported health status (Parkinson’s Disease Questionnaire (PDQ-39)). Two year outcomes were compared with those who started treatment within 1 year of diagnosis and those left untreated.

Results: 42 patients with PD were followed-up for 2 years, of whom 26 started treatment during the first year and 16 remained untreated. Those receiving treatment had significantly higher UPDRS and PDQ-39 scores at baseline. There was no significant deterioration in PDQ-39 score in either group (median change untreated 0.8 vs treated 4.0; p = 0.47), despite a significant difference in the change in motor UPDRS scores (untreated 6.0 vs treated −6.0; p = 0.03).

Conclusion: Given the lack of significant deterioration in the PDQ-39 in untreated patients, we believe a “wait and watch” strategy for the treatment of newly diagnosed PD remains a credible approach unless randomised trials prove otherwise.

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Footnotes

  • Funding: RC is supported by a grant from the Parkinson’s Disease Society.

  • Competing interests: None.

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