18547126

Source:http://linkedlifedata.com/resource/pubmed/id/18547126

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Predicate	Object
rdf:type	pubmed:Citation
lifeskim:mentions	umls-concept:C0013216, umls-concept:C0030567, umls-concept:C0030705, umls-concept:C0034380
pubmed:issue	7
pubmed:dateCreated	2008-6-12
pubmed:abstractText	Parkinson's disease is a common progressive neurodegenerative condition with multiple motor and nonmotor features contributing to impairment of health-related quality of life (HR-QOL). Pharmacological treatments have been directed primarily at dopamine replacement with levodopa and agents to improve its bioavailability, including DOPA decarboxylase inhibitors, catechol-O-methyltransferase (COMT) inhibitors and monoamine oxidase B (MAO-B) inhibitors, as well as synthetic dopamine agonists. These treatments to restore motor function are often very successful in early Parkinson's disease, with objective improvement and concomitant improvement in subjective HR-QOL scores. However, as the disease progresses, motor complications and nonmotor symptoms predominate and are often refractory to therapeutic interventions. Antiparkinsonian medications have been shown to improve motor severity and motor complications of advancing disease, and there is increasing evidence that this can be translated into subjective improvement of HR-QOL from a patient's point of view. However, the degree of improvement is less marked on HR-QOL scores than on motor scores, and some studies do not show improvement of HR-QOL in parallel to motor improvements. A number of explanations are possible, including limitations of the scales used, trial designs and lack of clinical improvement from the patients' point of view. This review concentrates on clinical trials with an index of HR-QOL as an outcome measure, with particular emphasis on well designed, randomized, double-blind, placebo-controlled or active comparator-controlled methodology. Drugs that have been more recently added to the armamentarium of Parkinson's disease, including the oral (pramipexole, ropinirole and piribedil) and transdermal (rotigotine) non-ergotamine-derived dopamine agonists, the novel MAO-B inhibitor rasagiline and the COMT inhibitors tolcapone and entacapone, were included. The effect of each of these agents on overall HR-QOL and depression, a factor that has been shown to significantly contribute to HR-QOL in several multivariate analyses, is discussed.Overall, the literature search revealed 14 double-blind, placebo- or active comparator-controlled trials with an index of HR-QOL as an outcome measure. Entacapone resulted in HR-QOL improvement in nonfluctuating patients (one study) but not clearly in those with motor fluctuations (two studies). Tolcapone was only tested in patients with motor fluctuations and resulted in significant improvement in two of four studies using HR-QOL as an outcome measure. Rasagiline improved HR-QOL as monotherapy in early Parkinson's disease (one study), but not clearly in more advanced disease (one study). Rotigotine improved HR-QOL in both early Parkinson's disease (one study) and more advanced disease with motor fluctuations (one study). The impact of ropinirole and pramipexole on HR-QOL as monotherapy in early Parkinson's disease versus placebo has not been assessed, but both agents have resulted in improved HR-QOL in patients with motor fluctuations (ropinirole one study, pramipexole one study). The evidence for antidepressant efficacy of antiparkinsonian medications is limited.
pubmed:language	eng
pubmed:journal	http://linkedlifedata.com/resource/pubmed/journal/9431220
pubmed:citationSubset	IM
pubmed:chemical	http://linkedlifedata.com/resource/pubmed/chemical/Antiparkinson Agents
pubmed:status	MEDLINE
pubmed:issn	1172-7047
pubmed:author	pubmed-author:GallagherDavid ADA, pubmed-author:SchragAnetteA
pubmed:issnType	Print
pubmed:volume	22
pubmed:owner	NLM
pubmed:authorsComplete	Y
pubmed:pagination	563-86
pubmed:meshHeading	pubmed-meshheading:18547126-Antiparkinson Agents, pubmed-meshheading:18547126-Disease Progression, pubmed-meshheading:18547126-Humans, pubmed-meshheading:18547126-Parkinson Disease, pubmed-meshheading:18547126-Quality of Life
pubmed:year	2008
pubmed:articleTitle	Impact of newer pharmacological treatments on quality of life in patients with Parkinson's disease.
pubmed:affiliation	Department of Clinical Neurosciences, Royal Free and University College Medical School, London, EnglandInstitute of Neurology, University College London, London, England.
pubmed:publicationType	Journal Article, Review, Research Support, Non-U.S. Gov't