title: Factors determining when to start levodopa/carbidopa/entacapone treatment in Spanish patients with Parkinson's disease.
abstract: BACKGROUND
  Several therapeutic options are available for the symptomatic treatment of Parkinson's disease (PD).There is no reliable information about which factors are involved in the choice of treatment.
  
  
  OBJECTIVE
  To identify factors contributing to the decision to start treatment with levodopa/carbidopa/entacapone (LCE) in patients with PD.
  
  
  METHODS
  We completed a descriptive cross-sectional retrospective multicentre study of patients with idiopathic PD receiving LCE. Clinical data were collected with special attention to factors that could potentially determine when to initiate treatment with LCE in normal clinical practice.
  
  
  RESULTS
  We studied 1050 patients with a mean age of 71.3±8.7 years (58.2% men). Average time from onset of symptoms to diagnosis was 13.8±12.9 months, with a latency time of 74.5±53.6 months before starting LCE treatment. The most common initial symptoms were tremor (70.6%), reduced dexterity (43.2%) and slowness of movement (41.5%). At the start of LCE treatment, most patients were in Hoehn and Yahr stage 2 (57.5%), with an average rating of 73.4% on the Schwab & England scale. Eight hundred twenty two patients (78.3%) received treatment with other drugs before starting LCE (mean time between starting any PD treatment and starting LCE was 40.5±47.2 months). Clinical factors with a moderate, marked, or crucial effect on the decision to start LCE treatment were bradykinesia (84.7%), daytime rigidity (72.2%), general decline (72.2%), difficulty walking (66.4%), tremor (62.7%), nocturnal rigidity (56.1%), and postural instability (53%). Difficulty performing activities of daily living was the only psychosocial factor identified as having an influence on the decision (84.3%).
  
  
  CONCLUSIONS
  The decision to start patients with idiopathic PD on LCE treatment is mainly determined by motor deficits and disabilities associated with disease progression.
authors: Unidad de Investigación, Centro Alzheimer Fundación Reina Sofía y CIBERNED, Instituto de Salud Carlos III, Madrid, España. Electronic address: pmartinez@fundacioncien.es.
authors: P
authors: P
authors: Martínez-Martín
authors: Departamento Médico, Novartis Farmacéutica SA, Barcelona, España.
authors: B
authors: B
authors: Hernández
authors: Departamento Médico, Novartis Farmacéutica SA, Barcelona, España.
authors: J
authors: J
authors: Ricart
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D002230:Carbidopa / Q000627:therapeutic use*; D002396:Catechols / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009570:Nitriles / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000188:drug therapy*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013030:Spain
chemical_list: D000978:Antiparkinson Agents; D002396:Catechols; D009570:Nitriles; D007980:Levodopa; C071192:entacapone; D002230:Carbidopa
keywords: Enfermedad de Parkinson; Levodopa/carbidopa/entacapona; Levodopa/carbidopa/entacapone; Parkinson's disease