title: Early DEtection of wEaring off in Parkinson disease: the DEEP study.
abstract: OBJECTIVE
  Assessing the frequency of Wearing-Off (WO) in Parkinson's disease (PD) patients, and its impact on Quality of Life (QoL).
  
  
  METHODS
  Consecutive ambulatory patients, who were on dopaminergic treatment for ≥ 1 year, were included in this multicentre, observational cross-sectional study. In a single visit, WO was diagnosed based on neurologist assessment as well as using the validated Italian version of a patient self-rated 19-question Wearing-Off Questionnaire (WOQ-19); WO was defined for scores ≥ 2. QoL was evaluated by the 8-item Parkinson's Disease Questionnaire (PDQ-8).
  
  
  RESULTS
  617 subjects were included, with a mean anti-Parkinson treatment duration of 6.6 ± 4.6 years, 87.2% were on levodopa treatment. Neurologists identified presence of WO in 351 subjects (56.9%), whereas 415 subjects (67.3%) were identified by the self-administered WOQ-19. In patients with a <2.5 years disease duration, WO was diagnosed in 12 subjects (21.8%) by neurologists and in 23 subjects (41.8%) by the WOQ-19. The most frequent WO symptoms, as identified by WOQ-19, were "slowness of movements" (55.8%) and "reduced dexterity" (48.8%). Younger age, female gender, Unified Parkinson's Disease Rating Scale (UPDRS) part II score and duration of anti-Parkinson treatment were found significantly associated with WO. The number of motor (p < 0.0001) and non-motor (p < 0.0001) WO symptoms correlated with PDQ-8 total score.
  
  
  CONCLUSIONS
  WO is common already at the early stages of PD and is underestimated by routine neurological clinical evaluation. The number of WO symptoms, both motor and non motor, increases along with disease duration and has a negative impact on patients QoL.
authors.affiliation: Department of Neurology, Institute of Research and Medical Care, IRCCS San Raffaele, Rome, Italy. Electronic address: fabrizio.stocchi@tin.it.
authors.forename: F
authors.initials: F
authors.lastname: Stocchi
authors.affiliation: Department for Parkinson's disease, IRCCS San Camillo, Venice, Italy. Electronic address: angelo3000@yahoo.com.
authors.forename: A
authors.initials: A
authors.lastname: Antonini
authors.affiliation: School of Medicine, University of Salerno, Salerno, Italy. Electronic address: pbarone@unisa.it.
authors.forename: P
authors.initials: P
authors.lastname: Barone
authors.affiliation: U.O. Neurologia Ospedale Civile Maggiore, Borgo Trento, Verona, Italy. Electronic address: michele.tinazzi@ospedaleuniverona.it.
authors.forename: M
authors.initials: M
authors.lastname: Tinazzi
authors.affiliation: Clinica Neurologica I Policlinico Universitario, Catania, Italy. Electronic address: m.zappia@unict.it.
authors.forename: M
authors.initials: M
authors.lastname: Zappia
authors.affiliation: CeSI-Centro Studi Invecchiamento Fondazione Università Gabriele D'Annunzio, Chieti, Italy. Electronic address: onofrj@unich.it.
authors.forename: M
authors.initials: M
authors.lastname: Onofrj
authors.affiliation: Neurologia Istituto Mediterraneo Neuromed, Isernia, Italy. Electronic address: stefano.ruggieri@uniroma1.it.
authors.forename: S
authors.initials: S
authors.lastname: Ruggieri
authors.affiliation: Dipartimento di Neuroscienze Università di Messina, Messina, Italy. Electronic address: morgante@unime.it.
authors.forename: L
authors.initials: L
authors.lastname: Morgante
authors.affiliation: U.O. Neurologia Ospedale Versilia, Lucca, Italy. Electronic address: u.bonuccelli@med.unipi.it.
authors.forename: U
authors.initials: U
authors.lastname: Bonuccelli
authors.affiliation: Neurologia 4 A.S.O. Molinette, Turin, Italy. Electronic address: leonardo.lopiano@unito.it.
authors.forename: L
authors.initials: L
authors.lastname: Lopiano
authors.affiliation: Neurologia Ospedale di Bolzano, Bolzano, Italy. Electronic address: peter.pramstaller@eurac.edu.
authors.forename: P
authors.initials: P
authors.lastname: Pramstaller
authors.affiliation: Neurologia I Istituto Nazionale Neurologico C. Besta, Università Cattolica del Sacro Cuore, Milan, Italy. Electronic address: alberto.albanese@unicatt.it.
authors.forename: A
authors.initials: A
authors.lastname: Albanese
authors.affiliation: Novartis Pharma Italia, Medical Department, Origgio, Italy. Electronic address: mahmood.attar@novartis.com.
authors.forename: M
authors.initials: M
authors.lastname: Attar
authors.affiliation: Novartis Pharma Italia, Medical Department, Origgio, Italy. Electronic address: valeria.posocco@novartis.com.
authors.forename: V
authors.initials: V
authors.lastname: Posocco
authors.affiliation: Novartis Pharma Italia, Medical Department, Origgio, Italy. Electronic address: delia.colombo@novartis.com.
authors.forename: D
authors.initials: D
authors.lastname: Colombo
authors.affiliation: Department of Neurosciences, University of Genoa, Genoa, Italy. Electronic address: giabbr@unige.it.
authors.forename: G
authors.initials: G
authors.lastname: Abbruzzese
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: Parkinson's disease; Quality of life; Wearing-off; Wearing-off questionnaire