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Please use this identifier to cite or link to this item: http://hdl.handle.net/10761/1505

Issue Date: 4-Feb-2014
Authors: Raciti, Loredana
Title: Wearing off identification using clinical assessments and self-reports in parkinson s disease. A Waking-day monitoring study
Abstract: Background: Parkinson s disease (PD) is characterized by motor fluctuations through the day due to L-dopa treatment. The wearing-off phenomenon is defined as a predictable, clinically relevant motor fluctuation which is routinely identify using clinical scales as well as self-reported questionnaires. Few studies have evaluated accuracy of such tools in identifying wearing-off using a waking-day monitoring study approach of patients motor status. Objectives: to assess diagnostic accuracy of clinical scales as well as self-reported questionnaires compared to an objective proposed tool obtained by a 12-h motor status monitoring in PD patients. Methods: Twenty-two PD patients were enrolled in the study. According to the item 36 of the UPDRS-ME part IV, N=11 patients were classified as fluctuating and N=11 as stable. All patients were clinically evaluated for 12 hours every 2 hours during the day and a Wearing Off Index (WOI) was computed to detect motor fluctuations. Patients also were tested using a self reported questionnaire (WOQ-19) and a 12-hours self diary (NOMO) to identify subjective perceptions of motor and non-motor fluctuations. Results: A WOI score between 2 to 3 was able to detect a wearing-off defined by the UPDRS, with a sensitivity of 90.9% and a specificity of 63.6%. WOQ-19 was less accurate to detect a wearing-off defined by the UPDRS, with a sensitivity and specificity of 90.9 % and 27.3%, respectively. When WOI was used as gold standard, UPDRS-IV item 36 revealed a sensitivity of. 71.4 % and a specificity of 87.5 % to detect the wearing-off, while the WOQ-19 presented a sensitivity of 85.7% and specificity of 25%. According to NOMO diary, fluctuating patients showed a greater percentage of non-motor fluctuations, in particular anxiety and depression (90% and 70%, respectively) even if fluctuating non motor symptoms were also identify in stable patients. Conclusions: our study provided some evidences about accuracy of commonly screening tools to detect wearing-off in clinical practice. A waking day monitoring approach, even if non routinelyapplicable in clinical practice, may be useful to accurately assess changes in motor status through the day due to changes in pharmacological regimen.
Appears in Collections:Area 06 - Scienze mediche

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RCTLDN79R51C351E-Tesi DOTTORATO RACITI LOREDANA_pdf.pdfWEARING OFF IDENTIFICATION USING CLINICAL ASSESSMENTS AND SELF-REPORTS IN PARKINSON’S DISEASE. A WAKING-DAY MONITORING STUDY1,01 MBAdobe PDFView/Open


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