A Survey Of Wearing Off In Parkinson’s Disease Patients In Shanghai Area

Objective: Wearing-off is a common motor complication of Parkinson’s disease,which seriously affects the quality of life and motor function of PD patients.We explore the epidemiological characteristics of WO in Shanghai and verify the effectiveness of The Chinese version of the 9-item wearing-off questionnaire in Chinese population.Methods: This observational cross-sectional study included 360 PD patients who received stable treatment in 4 hospitals in Yangpu District.The patients completed the CWOQ-9 independently before the evaluation by the clinician.Results:1.Among the 360 PD patients who met the admission criteria,there were205males(56.9%)and 115females(43.1%),the average age was 69.15 ±8.55 years,the average course of disease was 6.08 ±4.54 years,and the average H&Y grade was 2.31±0.99.Clinicians identified WO in 188patients(52.2%).The occurrence of WO is closely related to the age of onset,course of disease,daily dose of levodopa,LEDD,LEDD/BMI,the time of final use of levodopa and the time of anti-PD treatment.Through univariate binary Logistic regression equation analysis,it was concluded that the age of onset(OR = 0.970,P < 0.05)was the protective factor for the occurrence of WO.The risk factors of WO were LEDD/BMI(OR = 1.034,P<0.001),course of disease(OR = 1.118,P<0.001),daily levodopa dose(OR = 1.002,P<0.001),LEDD(OR = 1.002,P<0.001),final use time of levodopa(OR = 1.117,P<0.001)and antiPD therapy(OR = 1.113,P<0.001).2.CWOQ-9 found WO in 259(71.9%)patients.Among the 259 patients,181 cases of CWOQ-9 were consistent with clinicians’ assessment of WO.In this population,179(179/181,98.9%)patients had motor fluctuation,78 cases(78/181,43.1%)had nonmotor fluctuation,of which the most common MF was bradykinesia(137/181,76.2%),and the most common NMF was pain(44/181,24.3%).Most WO patients are mainly characterized by the presence of MF alone(103/181,57.0%)or accompanied by NMF(76/181,40.4%).Through the analysis of the basic characteristics of symptom fluctuation groups,it was found that LEDD/BMI,the daily levodopa dose,LEDD and the presence of stiffness were the influencing factors of MF with NMF.3.Among the 259(71.9%)patients with positive CWOQ-9 diagnosis,there were79 PD patients.Doctors disagreed with the existence of WO,to further analyze the reasons for the low specificity of CWOQ-9.The study found that there were statistical significance in age,LEDD/BMI,course of disease,daily levodopa dose,LEDD,final levodopa use time,anti-PD treatment time,total CWOQ-9 score,the presence of motor retardation and decreased mobility symptoms.Conclusions: The incidence of WO in patients with Parkinson’s disease is still high,and the clinical manifestations are complex and diverse.CWOQ-9 can effectively reduce the missed diagnosis of WO and has high sensitivity,so it can be widely used in clinical diagnosis and treatment.