Head-to-Head Comparison of the Neuropsychiatric Effect of Dopamine Agonists in Parkinson's Disease: A Prospective, Cross-Sectional Study in Non-demented Patients.
BACKGROUND
Dopaminergic agonists (DAs) are widely used to treat motor symptoms in Parkinson's disease (PD). The differential effect of DAs on neuropsychiatric symptoms of PD has not been accurately studied.


METHODS
We performed a prospective cross-sectional study of 515 non-demented PD patients receiving treatment with pramipexole [n = 250, monotherapy or with levodopa (L-dopa)], ropinirole (n = 150, monotherapy or with L-dopa), or L-dopa (n = 115, monotherapy); all formulations were immediate release. Neuropsychiatric disturbances were assessed through the Neuropsychiatric Inventory (NPI). Groups were matched in terms of age, education, sex, disease severity (Hoehn and Yahr), disease duration, executive function, total L-dopa daily equivalent dose, and concomitant psychotropic medications (antidepressants, anxiolytics and antipsychotic agents).


RESULTS
Patients on pramipexole showed significantly lower total NPI scores than patients on ropinirole (17.2 ± 11 vs. 20.9 ± 13, p = 0.015). Regarding the spectrum of neuropsychiatric symptoms, pramipexole was associated with significantly lower apathy scores than the L-dopa group (1.01 ± 1.7 vs. 1.87 ± 2.93, p = 0.02). The frequency of patients with clinically meaningful symptoms of apathy (NPI apathy scores ≥ 4) was significantly lower in the pramipexole group (11.2 %) than in the ropinirole (20.3 %) and L-dopa (23.8 %) groups (χ (2) 12.49, p = 0.002). No other significant differences were found in NPI subscores between groups.


CONCLUSIONS
This is the first head-to-head comparative study of the effect of DAs on neuropsychiatric disturbances in PD that has controlled the sample for the most important confounding factors. In comparable groups of patients, the use of pramipexole seems to be associated with a lower frequency and severity of apathetic symptoms.
Movement Disorders Unit, Department of Neurology, Sant Pau Hospital, Universitat Autònoma de Barcelona, Sant Antoni M. Claret 167, 08025, Barcelona, Spain.
Jesús
J
Pérez-Pérez
Javier
J
Pagonabarraga
Saül
S
Martínez-Horta
Ramón
R
Fernández-Bobadilla
Salvador
S
Sierra
Berta
B
Pascual-Sedano
Alexandre
A
Gironell
Jaime
J
Kulisevsky
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D057565:Apathy; D052160:Benzothiazoles / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004522:Educational Status; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000209:etiology* / Q000523:psychology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D000077487:Pramipexole; D011446:Prospective Studies; D011619:Psychotropic Drugs / Q000627:therapeutic use; D013030:Spain / Q000453:epidemiology
D000978:Antiparkinson Agents; D052160:Benzothiazoles; D018491:Dopamine Agonists; D007211:Indoles; D011619:Psychotropic Drugs; C046649:ropinirole; D007980:Levodopa; D000077487:Pramipexole