Mendorf Sarah, Witte Otto W, Zipprich Hannah, Prell Tino
Department of Neurology, Jena University Hospital, Jena, Germany.
Centre for Healthy Ageing, Jena University Hospital, Jena, Germany.
Front Neurol. 2020 Oct 19;11:551696. doi: 10.3389/fneur.2020.551696. eCollection 2020.
Nonadherence to medication is a common and serious issue in the treatment of patients with Parkinson's disease (PD). Among others, distinct nonmotor symptoms (NMS) were found to be associated with nonadherence in PD. Here, we aimed to confirm the association between NMS and adherence. In this observational study, the following data were collected: sociodemographic data, the German versions of the Movement Disorder Society-sponsored revision of the unified Parkinson's disease rating scale for motor function (MDS-UPDRS III), Hoehn and Yahr (H&Y) stage, levodopa equivalent daily dose (LEDD), Becks depression inventory II (BDI-II), nonmotor symptoms questionnaire (NMSQ), and the Stendal adherence to medication score (SAMS). The final sample included 137 people with PD [54 (39.4%) females] with a mean age of 71.3 ± 8.2 years. According to SAMS, 10.9% of the patients were fully adherent, 73% were moderately nonadherent, and 16.1% showed clinically significant nonadherence. Nonadherence was associated with LEDD, BDI-II, education level, MDS-UPDRS III, and the NMSQ. The number of NMS was higher in nonadherent patients than in adherent patients. In the multiple stepwise regression analysis, the items 5 (constipation), 17 (anxiety), and 21 (falls) predicted nonadherence to medication. These NMSQ items also remained significant predictors for SAMS after correction for LEDD, MDS-UPDRS III, BDI-II, age, education level, gender, and disease duration. Our study, in principle, confirms the association between NMS burden and nonadherence in PD. However, in contrast to other clinical factors, the relevance of NMSQ in terms of nonadherence is low. More studies with larger sample sizes are necessary to explore the impact of distinct NMS on adherence.
帕金森病（PD）患者治疗过程中，不遵医嘱服药是一个常见且严重的问题。除此之外，研究发现特定的非运动症状（NMS）与帕金森病患者不遵医嘱服药有关。在此，我们旨在证实非运动症状与服药依从性之间的关联。在这项观察性研究中，收集了以下数据：社会人口统计学数据、运动障碍协会赞助修订的帕金森病统一运动功能评定量表德语版（MDS-UPDRS III）、霍恩和亚尔（H&Y）分期、左旋多巴等效日剂量（LEDD）、贝克抑郁量表第二版（BDI-II）、非运动症状问卷（NMSQ）以及施滕达尔服药依从性评分（SAMS）。最终样本包括137例帕金森病患者[54例（39.4%）女性]，平均年龄为71.3±8.2岁。根据SAMS评分，10.9%的患者完全依从，73%的患者中度不依从，16.1%的患者表现出临床显著的不依从。不依从与LEDD、BDI-II、教育水平、MDS-UPDRS III以及NMSQ相关。不依从患者的非运动症状数量高于依从患者。在多元逐步回归分析中，条目5（便秘）、17（焦虑）和21（跌倒）可预测不遵医嘱服药情况。在校正LEDD、MDS-UPDRS III、BDI-II、年龄、教育水平、性别和病程后，这些NMSQ条目仍是SAMS的显著预测因子。我们的研究原则上证实了帕金森病患者非运动症状负担与不依从之间的关联。然而，与其他临床因素相比，NMSQ在不依从方面的相关性较低。需要更多样本量更大的研究来探讨特定非运动症状对依从性的影响。
