Levodopa–carbidopa intrajejunal infusion in Parkinson’s disease: untangling the role of age

• DOI: 10.1007/s00415-020-10356-x
• Publication Date: 2020-12-22T20:02:26Z
• Authors: Francesca Morgante; Valentina Oppo; Margherita Fabbri; Enrica Olivola; Chiara Sorbera; Rosa De Micco; Giovanna Chiara Ielo; Fabiana Colucci; Salvatore Bonvegna; Alessio Novelli; Nicola Modugno; Mariachiara Sensi; Maurizio Zibetti; Leonardo Lopiano; Alessandro Tessitore; Manuela Pilleri; Roberto Cilia; Antonio E. Elia; Roberto Eleopra; Lucia Ricciardi; Giovanni Cossu
• Keywords: Quality of life; Old age; Antiparkinson Agents; Levodopa; 03 medical and health sciences; 0302 clinical medicine; Humans; Gait Disorders, Neurologic; Dyskinesia; Levodopa–carbidopa intestinal gel (LCIG); Motor fluctuations; Old age; Parkinson’s disease; Quality of life; Aged; Aged, 80 and over; Antiparkinson Agents; Carbidopa; Cross-Sectional Studies; Drug Combinations; Gels; Humans; Italy; Levodopa; Quality of Life; Gait Disorders, Neurologic; Parkinson Disease; Aged; Aged, 80 and over; Original Communication; Dyskinesia; Carbidopa; Parkinson Disease; Levodopa–carbidopa intestinal gel (LCIG); Motor fluctuations; 3. Good health; Dyskinesia; Levodopa–carbidopa intestinal gel (LCIG); Motor fluctuations; Old age; Parkinson’s disease; Quality of life; Drug Combinations; Cross-Sectional Studies; Italy; Parkinson’s disease; Quality of Life; Gels

Abstract Objectives Levodopa–Carbidopa Intrajejunal gel (LCIG) infusion is an effective intervention for people with advanced Parkinson’s disease (PD). Although age may not be a limiting factor for LCIG implant, no data are available on late elderly PD (LE-PD) subjects. In this cross-sectional, we aimed to demonstrate if older age may impact on quality of life (QoL), motor and non-motor symptoms severity, and profile of side effects in PD treated with LCIG.

Methods Out of 512 PD subjects treated with LCIG at 9 Italian PD centers, we selected 25 LE-PD defined as age ≥ 80 years at last follow-up who were available to attend the study visit. Twenty-five PD patients (Control-PD, defined as age < 75 years at last follow-up) matched to LE-PD by disease and LCIG duration served as control group. The following motor and non-motor variables were ascertained: quality of life (PDQ-8), time spent in ON, wearing-off Questionnaire, Unified PD Rating Scale, freezing of gait questionnaire, Parkinson’s disease sleep scale-2, Non Motor Symptoms Scale (NMSS), and MOCA.

Results No statistically significant differences were found between LE-PD and Control-PD on PDQ-8 and several motor and non-motor variables. LE-PD had less frequent and milder impulsive–compulsive behaviors and milder dyskinesia. At multivariable regression, worse quality of life was associated with UPDRS-III and NMSS scores but not to age at study visit and age at LICG implant. Rate of adverse effects was similar in both groups. Drop-out rate calculated in the whole PD cohort was comparable between the two groups.

Conclusion Our data provide evidence that valuable LCIG infusion might be achieved in late elderly PD.