Pilot study of a new tool to optimise dopaminergic treatment in Parkinson's disease: the OPTIMIPARK questionnaire

Introduction. Dopaminergic therapy is effective in Parkinson's disease (PD), but should be adjusted as neurodegeneration progresses. Aims. The aim of this study was to develop a questionnaire (OPTIMIPARK) to assess the patient's dopaminergic status and assist the clinician in adjusting treatment. Patients and methods. The preliminary, self-administered version of OPTIMIPARK includes nine items that take into account motor and non-motor complications as well as disability. Each item is given a score between 0 and 2, and an overall score from 0 to 18 is obtained. Thirty patients completed the OPTIMIPARK questionnaire and an ad hoc questionnaire about it in a single-centre, observational pilot study. Feasibility, acceptability and preliminary agreement with clinical criteria were analysed. Results. Thirty patients with PD (68.5 +/- 7.5 years; range: 43-80 years) in Hoehn & Yahr stage I-III completed OPTIMIPARK (mean total score: 6.7 +/- 4; range: 0-14) and the ad hoc questionnaire. Clinical decisions were classified as: 'no change', 'adjustments to conventional treatment' and 'surgical or continuous infusion therapy'. The total OPTIMIPARK scores (mean +/- standard deviation) for each option were: 1.4 +/- 1 (range: 0-3); 7 +/- 2.8 (range: 2-11); and 10.8 +/- 1.8 (range: 9-14). The 3/4 cut-off point classified 95.5% of patients as 'no change' versus 'adjustment to conventional treatment', and the 9/10 cut-off point discriminated 78.3% of patients from 'adjustment to conventional treatment' versus 'surgical or continuous infusion therapy', with a concordance (kappa and Lin coefficients) of 0.81. Conclusions. Although still pending a validation study, OPTIMIPARK may be a viable and useful questionnaire for clinical decision-making in the therapeutic adjustment of PD patients and the identification of candidates for advanced therapies.