Article

A multicentre longitudinal observational study of changes in self reported health status in people with Parkinson's disease left untreated at diagnosis

London Metropolitan University, Londinium, England, United Kingdom
Journal of neurology, neurosurgery, and psychiatry (Impact Factor: 5.58). 06/2007; 78(5):465-9. DOI: 10.1136/jnnp.2006.098327
Source: PubMed

ABSTRACT The issue of when to start treatment in Parkinson's disease (PD) remains controversial. Some favour treatment at diagnosis while others opt for a "wait and watch" policy. The effect of the latter policy on the self reported health status of people with PD is unknown.
To record self reported health status through longitudinal use of a validated PD specific questionnaire (PDQ-39) in untreated PD patients in multiple centres in the UK. To compare patients who were left untreated with those who were offered treatment during follow-up.
A multicentre, prospective, "real life" observational audit based study addressing patient reported outcomes in relation to self reported health status and other sociodemographic details.
198 untreated PD were assessed over a mean period of 18 months. During two follow-up assessments, the self reported health status scores in all eight domains of the PDQ-39 and the overall PDQ-39 summary index worsened significantly (p<0.01) in patients left untreated. In a comparative group in whom treatment was initiated at or soon after diagnosis, there was a trend towards improvement in self reported health status scores after treatment was started.
This study addresses for the first time self reported health status, an indicator of health related quality of life, in untreated PD. The findings may strengthen the call for re-evaluation of the policy to delay treatment in newly diagnosed patients with PD.

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    • "Mean age at first recorded purchase was 69 for both prevalent and incident cases, higher than the range 58–63 often reported in studies as age at onset/diagnosis [6], but in accordance with several population-based studies that reported age at onset between 66 and 71 [6, 24, 29–31]. Evidently, age at first medication purchase is a proxy of diagnosis age rather than onset of symptoms, and also includes a lagtime to treatment initiation, which may be longer than one year [24] [32]. The high age may also result from over-representation of patients with treatment initiation at older age, although we tried to minimize this bias by excluding cases with first purchase at 85 years of age or later, when diagnosis is very challenging and empiric treatment is common [16]. "
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