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Study Underscores Benefits of Taking Parkinsonís Medicines On-Schedule

As Parkinson’s disease (PD) progresses, most people need to take several medications at specific times throughout the day. A new study finds that one-on-one counseling can help people with PD keep on track with complicated medication schedules — and as a result, improve mobility, emotional well-being and quality of life. The results appear in the April 20 online edition of the International Journal of Clinical Practice.

There are several drugs availble to ease the motor symptoms experienced by people with Parkinson’s.  However, in order to work, these drugs, such as the gold-standard, carbidopa/levodopa (Sinemet®) must be taken on time. Getting off schedule can lead to side effects, including dyskinesias, or the return of PD symptoms.  Add to this the cognitive difficulties that some people with PD may experience, and remembering to take medications on time can become a real challenge. 

Researchers led by David James Daley, Ph.D., at the University of East Anglia, United Kingdom, tested a counseling approach called adherence therapy with 38 people with PD. An additional 38 people with PD attended their usual medical appointments but did not receive therapy. (Researchers originally invited 427 people to take part, 173 of whom were found to adhere to their medications schedules).

Participants in this phase II clinical trial were on average 72 years old and taking 13 tablets daily for both Parkinson’s and non-Parkinson’s health conditions. Adherence therapy consisted of seven weekly one-on-one sessions to discuss attitudes toward medications and side effects, practical issues that get in the way of taking medicine on schedule, overall experience with medications, and any ambivalence or concerns about them. In addition, PD movement, cognitive, and mood symptoms, as well as quality of life, were assessed at the beginning of the study and at seven and 12 weeks.

Results

  • Among the 76 who participated, most people who missed doses of medication, or took it at the wrong time, did so because of forgetfulness.
  • People who took medication at the wrong time often reported that they did not understand how the drugs work, and the reasons for taking them at precise times.
  • Some people who did not take their medication on schedule were ambivalent about taking the drugs, depressed or in denial about their symptoms.
  • At 12 weeks, 60 percent of the people who received therapy saw improvements in taking their medications on time, compared with 16 percent of those who were not counseled.
  • People who received adherence therapy experienced significant improvement in mobility, activities of daily living, emotional wellbeing, cognition, communication and body discomfort compared with those who were not counseled.

What Does It Mean?

Treating the symptoms of PD can often require complicated medication schedules. Previous studies have shown that when people take their medications on time, they tend to feel better. Yet, many people do not stick to their schedules, which could impact how they feel.

In this study, the adherence therapy approach provided a relatively simple way to improve PD symptoms in the short term. And this improvement could be positively reinforcing — e.g., once someone feels better, or more alert, it might help people remember to take their medication. This study also underscores that medication timing, as well as dose, is critical to experiencing the benefits of PD drugs.  

Further research will be needed to find out if people who receive adherence therapy continue to take their medications on time over the long term. Nevertheless, taking one’s PD medications on time may be a straightforward way to improving quality of life.

While adherence therapy is not available in the United States, (except for possibly in clinical trials) PDF encourages people with PD to have an honest discussion with their movement disorder specialists about following their prescribed medication regimen. It is recommended that people with Parkinson’s understand how the drugs work, and the reasons for taking them at precise times.

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Reference: Daley DJ, Deane KHO, Gray RJ, Clark AB, Pfeil M, Sabanathan K, Worth PF, Myint PK (2014) Adherence therapy improves medication adherence and quality of life in people with Parkinson's disease: a randomised controlled trial. Int J Clin Pract. DOI: 10.1111/ijcp.12439  http://dx.doi.org/10.1111/ijcp.12439

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Source Date: Jun 09 2014