Early DEtection of wEaring off in Parkinson disease: The DEEP study

Objective: Assessing the frequency of Wearing-Off (WO) in Parkinson's disease (PD) patients, and its impact on Quality of Life (QoL). Methods: Consecutive ambulatory patients, who were on dopaminergic treatment for1 year, were included in this multicentre, observational cross-sectional study. In a single visit, WO was diagnosed based on neurologist assessment as well as using the validated Italian version of a patient self-rated 19- question Wearing-Off Questionnaire (WOQ-19); WO was defined for scores2. QoL was evaluated by the 8-item Parkinson ' s Disease Questionnaire (PDQ-8). Results: 617subjectswereincluded,withameananti-Parkinsontreatmentdurationof6.6 4.6years,87.2% were on levodopa treatment. Neurologists identi fi ed presence of WO in 351 subjects (56.9%), whereas 415 subjects (67.3%) were identi fi ed by the self-administered WOQ-19. In patients with a < 2.5 years disease duration,WOwasdiagnosedin12subjects(21.8%)byneurologistsandin23subjects(41.8%)bytheWOQ-19. The most frequent WO symptoms, as identi fi ed by WOQ-19, were " slowness of movements " (55.8%) and " reduced dexterity " (48.8%). Younger age, female gender, Uni fi ed Parkinson ' s Disease Rating Scale (UPDRS) part II score and duration of anti-Parkinson treatment were found signi fi cantly associated with WO. The numberofmotor( p < 0.0001)andnon-motor( p < 0.0001)WOsymptomscorrelatedwithPDQ-8totalscore. Conclusions: WO is common already at the early stages of PD and is underestimated by routine neuro- logical clinical evaluation. The number of WO symptoms, both motor and non motor, increases along with disease duration and has a negative impact on patients QoL.