5-2-1 Criteria: A Simple Screening Tool for Identifying Advanced PD Patients Who Need an Optimization of Parkinson's Treatment

Abstract

Objective: 5- (5 times oral levodopa tablet taken/day) 2- (2 hours of OFF time/day) 1- (1 hour/day of troublesome dyskinesia) criteria have been proposed by a Delphi expert consensus panel for diagnosing advanced Parkinson's disease (PD). The aim of the present study is to compare quality of life (QoL) in PD patients with "5-2-1 positive criteria" vs QoL in PD patients without "5-2-1 positive criteria" (defined as meeting >/=1 of the criteria). Methods: This is a cross-sectional, observational, monocenter study. Three different instruments were used to assess QoL: the 39-Item Parkinson's Disease Quality of Life Questionnaire Summary Index Score (PDQ-39SI); a subjective rating of perceived QoL (PQ-10); and the EUROHIS-QOL 8-Item Index (EUROHIS-QOL8). Results: From a cohort of 102 PD patients (65.4 +/- 8.2 years old, 53.9% males; disease duration 4.7 +/- 4.5 years), 20 (19.6%) presented positive 5-2-1 criteria: 6.9% for 5, 17.6% for 2, and 4.9% for 1. 37.5% (12/32) and 25% (5/20) of patients with motor complications and dyskinesia, respectively, presented 5-2-1 negative criteria. Both health-related (PDQ-39SI, 25.6 +/- 14 vs 12.1 +/- 9.2; p < 0.0001) and global QoL (PQ-10, 6.1 +/- 2 vs 7.1 +/- 1.3; p=0.007; EUROHIS-QOL8, 3.5 +/- 0.5 vs 3.7 +/- 0.4; p=0.034) were worse in patients with 5-2-1 positive criteria. Moreover, nonmotor symptoms burden (Non-Motor Symptoms Scale total score, 64.8 +/- 44.8 vs 39.4 +/- 35.1; p < 0.0001) and autonomy for activities of daily living (ADLS scale, 73.5 +/- 13.1 vs 89.2 +/- 9.3; p < 0.0001) were worse in patients with 5-2-1 positive criteria. Patient's principal caregiver's strain (Caregiver Stain Index, 4.3 +/- 3 vs 1.5 +/- 1.6; p < 0.0001), burden (Zarit Caregiver Burden Inventory, 28.4 +/- 12.5 vs 10.9 +/- 9.8; p < 0.0001), and mood (Beck Depression Inventory II, 12.2 +/- 7.2 vs 6.2 +/- 6.1; p < 0.0001) were worse in patients with 5-2-1 positive criteria as well. Conclusions: QoL is worse in patients meeting >/=1 of the 5-2-1 criteria. This group of patients and their caregivers are more affected as a whole. These criteria could be useful for identifying patients in which it is necessary to optimize Parkinson's treatment.