Treatment adherence and related factors in Parkinson's disease patients without dementia

Abstract

Background and Objective: Patients with Parkinson’s Disease (PD) have many risk factors for treatment nonadherence, such as cognitive impairment, depression, polypharmacy, and medication regimen complexity. Adherence in PD should be carefully monitored to accurately assess the patient’s clinical and treatment responseMethod: This is a cross-sectional observational study. Sixty patients who were diagnosed with PD according to the UK PD Association’s Brain Bank criteria and had at least primary school education participated in our study. Patients with a diagnosis of dementia or who received deep brain stimulation, apomorphine infusion, and levodopa/carbidopa intestinal gel therapy were excluded from the study. Main outcome measures: Adherence was evaluated with the 4-item Morisky medication adherence scale. The course of the patients was gauged with the MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). MDS-UPDRS subscores are as follows; Part 1: nonmotor experiences of daily life Part 2: motor experiences of daily life Part 3: motor examination Part 4: motor complications. In the evaluation of patients, Schwab and England Activities of Daily Living Rating Scale (SE-ADL) was used for activities of daily living, MoCA for cognitive status, Beck Depression and anxiety scales for mood. The number of drugs used by the patients and LDED were calculated. Results: The mean age of the patients was 62.40 (± 10.25) and 70% of them were male (n:42). There was no significant difference between the adherence of the patients according to the Hoehn and Yahr stages. There was a significant correlation between adherence and depression (p 0.005, r - 0.372), anxiety (0.009 r - 0.357), UPDRS-1 (p 0.006 r - 0.373), UPDRS-2 (p 0.027 r - 0.304), SEADL (p 0.001, r 0.438) scores. When these variables were included in the regression analysis with the enter method, SE-ADL score were found to be significant for predicting adherence (p 0.041, OR 0.328). Conclusion: Motor and non-motor problems of daily life are associated with non-adherence in PD patients without dementia. Treatment of non-motor symptoms such as depression and anxiety may contribute to adherence. Higher independence of patients in daily life increases adherence.