Research Article

Compliance with National and International Guidelines in the Treatment of Nonmotor Symptoms in Late-Stage Parkinson’s Disease

Table 4

Pharmacological treatment of nonmotor symptoms in late-stage PD in relation to the recommendations of the International Parkinson and Movement Disorder Society (n = 107).

Total cohortSymptom presenta(n, %)Symptomatic individualsb(n, %)

Neuropsychiatric symptoms
 Depression and depressive symptomsc
  Dopamine agonists
   Pramipexoled Clin useful39 (36%)17 of 37 (46%)20 of 63 (32%)
 Tricyclic antidepressants
  NortriptylinePos useful000
  DesipraminePos useful000
  AmitriptylinePos useful1 (1%)01 of 63 (2%)
 SSRI/SNRI
  CitalopramPos useful14 (13%)3 of 37 (8%)11 of 63 (17%)
  SertralinePos useful6 (6%)2 of 37 (5%)4 of 63 (6%)
  ParoxetinePos useful000
  FluoxetinePos useful1 (1%)01 of 63 (2%)
  VenlafaxineClin useful6 (6%)1 of 37 (3%)5 of 63 (8%)
 Anxiety and anxiety symptomse
 Apathy
  Dopamine agonists
   PiribedilPos useful000
 Acetylcholinesterase inhibitors
  Rivastigminef Pos useful15 (14%)14 of 60 (23%)9 of 27 (33%)
 Psychosisg
  ClozapineClin ueful9 (8%)
  QuetiapinePos useful20 (19%)
  Pimavanserin000
 Hallucinations
  ClozapineClin ueful6 of 49 (12%)2 of 18 (11%)
  QuetiapinePos useful10 of 49 (20%)7 of 18 (39%)
 Delusions
  ClozapineClin ueful6 of 27 (22%)3 of 13 (23%)
  QuetiapinePos useful6 of 27 (22%)2 of 13 (15%)
 Dementiah
 Acetylcholinesterase inhibitors
  DonepezilPos useful4 (4%)3 of 60 (5%)1 of 27 (4%)
  RivastigmineClin useful15 (14%)14 of 60 (23%)9 of 27 (33%)
  GalantaminePos useful000
Autonomic dysfunction
 Droolingi
  GlycopyrrolatePos useful000
  Botulinum toxinClin useful4 (4%)2 of 65 (3%)2 of 42 (5%)
 Orthostatic hypotensionj
  FludrocortisonePos useful6 (6%)
  MidodrinePos useful16 (15%)
  DroxidopaPos useful1 (1%)
 Light headedness
  FludrocortisonePos useful4 of 54 (7%)3 of 19 (16%)
  MidodrinePos useful10 of 54 (19%)7 of 19 (37%)
  DroxidopaPos useful00
 Fainting
  FludrocortisonePos useful3 of 21 (14%)0
  MidodrinePos useful7 of 21 (33%)5 of 8 (63%)
  DroxidopaPos useful00
 Urinary dysfunctionk
  Frequency, urgency and/or urge incontinence
   SolifenacinPos useful3 (3%)3 of 58 (5%)0
 Erectile dysfunction
  Sexual dysfunction
   SildenafilClin useful000
 Gastrointestinal dysfunction
  Constipationl
   MacrogolPos useful54 (50%)33 of 58 (57%)19 of 35 (54%)
   Lubiprostone000
Anorexia, nausea and vomiting associated with L-dopa or DA treatment
  Domperidonem Pos useful2 (2%)NAvNAv
Disorders of sleep and wakefulness
 Sleep fragmentation and insomnian
 Insomnia
  Dopamine agonists
   Rotigotineo Pos useful2 (2%)2 of 31 (6%)1 of 16 (6%)
  Hypnotics
   EszopiclonePos useful15 (14%)5 of 31 (16%)3 of 16 (19%)
  Melatonin
   3–5 mgPos useful2 (2%)p1 of 31 (3%)1 of 16 (6%)
 Rapid eye movement sleep behavior disorder
 Excessive daytime sleepinessq
  Psychoactive drugs
   ModafinilPos useful1 (1%)1 of 63 (2%)0
Others
 Painr
  Oxycodone-naloxone prolonged releasePos useful4 (4%)2 of 54 (4%)2 of 33 (6%)
 Fatigues
  MAO-B inhibitors
   RasagilinePos useful14 (13%)10 of 69 (14%)4 of 40 (10%)

PD, Parkinson’s disease; q1–q3, first and third quartiles; MMSE, mini-mental state examination (0–30, higher = better); GDS-30, geriatric depression scale (0–30, higher = worse); SSRI, selective serotonin reuptake inhibitor; NaSSA, noradrenergic and specific serotonergic antidepressants; SNRI, serotonin-norepinephrine reuptake inhibitors; TCA, tricyclic antidepressants; L-dopa, levodopa; DA, dopamine agonists; MAO-B, monoamine oxidase B. NAv, information nonavailable. Not available in Sweden. Table includes treatment rated by the International Parkinson and Movement Disorder Society as clinically useful and possibly useful, while investigational and not useful treatments are not listed. aSymptom present, individuals with score ≥1 on item of the NMSS scored 0–12 (higher = worse), if nothing else is stated. bSymptomatic individuals include those who score above the cutoff of ≥6 (moderate–severe) on item of the NMSS, if nothing else is stated. cDepressive symptoms based on GDS-30 cutoff for depression (≥10 points): symptom present 1–9 points, symptomatic individuals ≥10 points. dIndication not known. eAnxiety score refer to (NMSS item 9) feel nervous, as no other specific data for anxiety was collected. fIndication not known. gPsychotic symptoms scores refer to item 13 (hallucinations) and item 14 (delusions) of the NMSS. hDementia as assessed by the MMSE, cutoffs cognitive impairment ≤23/dementia ≤18 MMSE. Treatment alternatives for cognitive impairment are all investigational and hence not listed. iSiallorhea based on item 18 of the NMSS. jOrthostatic hypotension refer to item 1 (lightheadedness) and item 2 (fainting) of the NMSS. kUrinary urgency/nocturia based on domain 7 of the NMSS. lConstipation based on item 21 of the NMSS. mIndication not known. nInsomnia based on item 5 of the NMSS. oIndication not known. pBoth individuals on Melatonin 2 mg qDaytime sleepiness based on item 3 of the NMSS. rPain based on item 27 of the NMSS. sFatigue based on item 4 of the NMSS.