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 cohort	Symptom present^a(n, %)	Symptomatic individuals^b(n, %)
Neuropsychiatric symptoms
Depression and depressive symptoms^c
Dopamine agonists
Pramipexole^d Clin useful	39 (36%)	17 of 37 (46%)	20 of 63 (32%)
Tricyclic antidepressants
Nortriptyline^Pos useful	0	0	0
Desipramine^Pos useful	0	0	0
Amitriptyline^Pos useful	1 (1%)	0	1 of 63 (2%)
SSRI/SNRI
Citalopram^Pos useful	14 (13%)	3 of 37 (8%)	11 of 63 (17%)
Sertraline^Pos useful	6 (6%)	2 of 37 (5%)	4 of 63 (6%)
Paroxetine^Pos useful	0	0	0
Fluoxetine^Pos useful	1 (1%)	0	1 of 63 (2%)
Venlafaxine^Clin useful	6 (6%)	1 of 37 (3%)	5 of 63 (8%)
Anxiety and anxiety symptoms^e
Apathy
Dopamine agonists
Piribedil^Pos useful	0	0	0
Acetylcholinesterase inhibitors
Rivastigmine^f Pos useful	15 (14%)	14 of 60 (23%)	9 of 27 (33%)
Psychosis^g
Clozapine^Clin ueful	9 (8%)
Quetiapine^Pos useful	20 (19%)
Pimavanserin	0	0	0
Hallucinations
Clozapine^Clin ueful		6 of 49 (12%)	2 of 18 (11%)
Quetiapine^Pos useful		10 of 49 (20%)	7 of 18 (39%)
Delusions
Clozapine^Clin ueful		6 of 27 (22%)	3 of 13 (23%)
Quetiapine^Pos useful		6 of 27 (22%)	2 of 13 (15%)
Dementia^h
Acetylcholinesterase inhibitors
Donepezil^Pos useful	4 (4%)	3 of 60 (5%)	1 of 27 (4%)
Rivastigmine^Clin useful	15 (14%)	14 of 60 (23%)	9 of 27 (33%)
Galantamine^Pos useful	0	0	0
Autonomic dysfunction
Drooling^i
Glycopyrrolate^Pos useful	0	0	0
Botulinum toxin^Clin useful	4 (4%)	2 of 65 (3%)	2 of 42 (5%)
Orthostatic hypotension^j
Fludrocortisone^Pos useful	6 (6%)
Midodrine^Pos useful	16 (15%)
Droxidopa^Pos useful	1 (1%)
Light headedness
Fludrocortisone^Pos useful		4 of 54 (7%)	3 of 19 (16%)
Midodrine^Pos useful		10 of 54 (19%)	7 of 19 (37%)
Droxidopa^Pos useful		0	0
Fainting
Fludrocortisone^Pos useful		3 of 21 (14%)	0
Midodrine^Pos useful		7 of 21 (33%)	5 of 8 (63%)
Droxidopa^Pos useful		0	0
Urinary dysfunction^k
Frequency, urgency and/or urge incontinence
Solifenacin^Pos useful	3 (3%)	3 of 58 (5%)	0
Erectile dysfunction
Sexual dysfunction
Sildenafil^Clin useful	0	0	0
Gastrointestinal dysfunction
Constipation^l
Macrogol^Pos useful	54 (50%)	33 of 58 (57%)	19 of 35 (54%)
Lubiprostone	0	0	0
Anorexia, nausea and vomiting associated with L-dopa or DA treatment
Domperidone^m Pos useful	2 (2%)	NAv	NAv
Disorders of sleep and wakefulness
Sleep fragmentation and insomnia^n
Insomnia
Dopamine agonists
Rotigotine^o Pos useful	2 (2%)	2 of 31 (6%)	1 of 16 (6%)
Hypnotics
Eszopiclone^Pos useful	15 (14%)	5 of 31 (16%)	3 of 16 (19%)
Melatonin
3–5 mg^Pos useful	2 (2%)^p	1 of 31 (3%)	1 of 16 (6%)
Rapid eye movement sleep behavior disorder
Excessive daytime sleepiness^q
Psychoactive drugs
Modafinil^Pos useful	1 (1%)	1 of 63 (2%)	0
Others
Pain^r
Oxycodone-naloxone prolonged release^Pos useful	4 (4%)	2 of 54 (4%)	2 of 33 (6%)
Fatigue^s
MAO-B inhibitors
Rasagiline^Pos useful	14 (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.