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Michael Serbin,1 Connie Marras,2 Carol Mansfield,3 Colton Leach,3 Charles Yonan,1 Margaret Sheehan,4 Anne Donnelly,5 Olga Klepitskaya1 1Neurocrine Biosciences, Inc., San Diego, CA, USA; 2The Edmond J. Safra Program in Parkinson’s Disease, University Health Network, University of Toronto, Toronto, ON, Canada; 3RTI Health Solutions, Research Triangle Park, NC, USA; 4Ashurst, Washington, DC, USA; 5Kellogg School of Management, Northwestern University, Evanston, IL, USACorrespondence: Carol Mansfield, RTI Health Solutions, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC, 27709, USA, Tel +19195418053, Email carolm@rti.orgBackground: Several adjunctive medications are available to reduce OFF time between levodopa/carbidopa (LD/CD) doses for people with Parkinson’s disease (PD).Objective: To explore how individuals with PD balance benefits and burdens when considering adjunctive medications.Methods: US adults (30– 83 years) with self-reported PD, currently treated with LD/CD, who experienced OFF episodes were recruited through the Fox Insight study to complete a discrete-choice experiment survey. Respondents selected among experimentally designed profiles for hypothetical adjunctive PD treatments that varied in efficacy (additional ON time), potential adverse effects (troublesome dyskinesia, risk of diarrhea, risk of change in bodily fluid color), and dosing frequency or the option “No additional medicine”. Data were analyzed with random-parameters logit models.Results: Respondents (N=480) would require ≥ 60 additional minutes of daily ON time to accept either a 40% risk of change in bodily fluid color or 10 additional minutes with troublesome dyskinesia daily. Respondents would require 40 additional minutes of daily ON time to accept a 10% risk of diarrhea and 22 additional minutes of daily ON time to switch from 1 additional pill each day to 1 pill with each LD/CD dose. On average, respondents preferred adjunctive PD medication over no additional medication. Results predicted that 59.1% of respondents would select a hypothetical treatment profile similar to opicapone, followed by no additional medication (27.5%) and a hypothetical treatment profile similar to entacapone (13.4%).Limitations: The data collected were based on responses to hypothetical choice profiles in the survey questions. The attributes and levels selected for this study were intended to reflect the characteristics of opicapone and entacapone; attributes associated with other adjunctive therapies were not evaluated.Conclusion: Patients with PD expressed interest in adjunctive treatment to increase ON time and would accept reduced ON time to avoid adverse effects.Plain Language Summary: People with Parkinson’s disease may experience OFF time, when their symptoms return between doses of levodopa/carbidopa. Some medicines can reduce OFF time when taken in addition to levodopa/carbidopa. These additional medicines have their own benefits and side effects. In this study, researchers used a survey to understand what side effects people with Parkinson’s disease would accept to have more ON time. Respondents were presented with a series of choices between 2 hypothetical medicines that increased daily ON time or no additional medicine. The medicines were described by 5 features (benefits and side effects). Respondents’ answers to the survey questions allowed researchers to estimate which unwanted side effects people with Parkinson’s disease would accept in exchange for additional ON time. The most important features of a medicine to reduce OFF time, in order, were (1) Lower risk of a change in urine, sweat, or saliva color; (2) Fewer additional minutes with troublesome dyskinesia each day; and (3) Increase in daily ON time. Introducing a 40% risk of change in urine, sweat, or saliva color (from no risk) would require more than 60 minutes of additional daily ON time to offset. An additional 10 minutes of troublesome dyskinesia each day would require more than 60 minutes of additional daily ON time. Introducing a 10% risk of diarrhea (from no risk) would require 40 minutes of additional ON time. Individuals’ preferences for the key features of medications that reduce OFF time for people with Parkinson’s disease should be considered when making treatment decisions.Keywords: discrete choice, Parkinson’s, stated preferences

Parkinson disease (PD) is the second most common age-related neurodegenerative condition diagnosed in North America. We recently demonstrated, using multiple epidemiological data sources, that the prevalence of PD diagnoses was greater than previously reported and currently used for clinical, research, and policy decision-making. Prior PD incidence estimates have varied, for unclear reasons. There is a need for improved estimates of PD incidence, not only for care delivery planning and future policy but also for increasing our understanding of disease risk. The objective of this study was thus to investigate the incidence of Parkinson disease across five epidemiological cohorts in North America in a common year, 2012. The cohorts contained data on 6.7 million person-years of adults ages 45 and older, and 9.3 million person-years of adults ages 65 and older. Our estimates of age-sex-adjusted incidence of PD ranged from 108 to 212 per 100,000 among persons ages 65 and older, and from 47 to 77 per 100,00 among persons ages 45 and older. PD incidence increased with age and was higher among males. We also found persistent spatial clustering of incident PD diagnoses in the U.S. PD incidence estimates varied across our data sources, in part due to case ascertainment and diagnosis methods, but also possibly due to the influence of population factors (prevalence of genetic risk factors or protective markers) and geographic location (exposure to environmental toxins). Understanding the source of these variations will be important for health care policy, research, and care planning.

Estimates of the prevalence of Parkinson's disease in North America have varied widely and many estimates are based on small numbers of cases and from small regional subpopulations. We sought to estimate the prevalence of Parkinson's disease in North America by combining data from a multi-study sampling strategy in diverse geographic regions and/or data sources. Five separate cohort studies in California (2), Minnesota (1), Hawaii USA (1), and Ontario, Canada (1) estimated the prevalence of PD from health-care records (3), active ascertainment through facilities, large group, and neurology practices (1), and longitudinal follow-up of a population cohort (1). US Medicare program data provided complementary estimates for the corresponding regions. Using our age- and sex-specific meta-estimates from California, Minnesota, and Ontario and the US population structure from 2010, we estimate the overall prevalence of PD among those aged ≥45 years to be 572 per 100,000 (95% confidence interval 537-614) that there were 680,000 individuals in the US aged ≥45 years with PD in 2010 and that that number will rise to approximately 930,000 in 2020 and 1,238,000 in 2030 based on the US Census Bureau population projections. Regional variations in prevalence were also observed in both the project results and the Medicare-based calculations with which they were compared. The estimates generated by the Hawaiian study were lower across age categories. These estimates can guide health-care planning but should be considered minimum estimates. Some heterogeneity exists that remains to be understood.

This article reviews and summarizes 200 years of Parkinson's disease. It comprises a relevant history of Dr. James Parkinson's himself and what he described accurately and what he missed from today's perspective. Parkinson's disease today is understood as a multietiological condition with uncertain etiopathogenesis. Many advances have occurred regarding pathophysiology and symptomatic treatments, but critically important issues are still pending resolution. Among the latter, the need to modify disease progression is undoubtedly a priority. In sum, this multiple-author article, prepared to commemorate the bicentenary of the shaking palsy, provides a historical state-of-the-art account of what has been achieved, the current situation, and how to progress toward resolving Parkinson's disease. © 2017 International Parkinson and Movement Disorder Society.

Background/aimsThe role of cognitive reserve in Parkinson's disease (PD)-mild cognitive impairment (MCI) is incompletely understood.MethodsThe relationships between PD-MCI, years of education, and estimated premorbid IQ were examined in 119 consecutive non-demented PD patients using logistic regression models.ResultsHigher education and IQ were associated with reduced odds of PD-MCI in univariate analysis. In multivariable analysis, a higher IQ was associated with a significantly decreased odds of PD-MCI, but education was not.ConclusionThe association of higher IQ and decreased odds of PD-MCI supports a role for cognitive reserve in PD, but further studies are needed to clarify the interaction of IQ and education and the impact of other contributors such as employment and hobbies.

The development of dyskinesias and motor fluctuations is a major concern related to dopaminergic treatment for Parkinson's disease. These motor complications are common, (1) and can be a significant source [...]

A case of multiple arterial thrombosis/ embolisms in a 74-year-old Caucasian man with no other cardiovascular risk factors who received Ad26.COV2-S vaccine 16 days before is reported. The unusual presentation required a longer diagnostic workup. The clinical manifestations and the therapy-specific response suggest an unusual presentation of Vaccine-induced immune thrombotic thrombocytopenia (VITT). [ABSTRACT FROM AUTHOR]