Effects of dopaminergic drug adjustment on executive function in different clinical stages of Parkinson’s disease

Hidetomo Murakami, Tetsuhito Nohara, Hidenobu Shozawa, Yoshiyuki Owan, Takeshi Kuroda, Satoshi Yano, Machiko Kezuka, Mitsuru Kawamura, Kenjiro Ono Department of Neurology, School of Medicine, Showa University, Tokyo, Japan Background: Effects of dopaminergic medication on executive function in patients with Parkinson’s disease (PD) are inconsistent. Objective: We examined the effect of dopaminergic medication on executive function in 24 drug-naïve PD patients (de novo group) and in 21 PD patients on chronic dopaminergic medication (chronic medication group). Methods: PD patients without dementia were included in this study. For the de novo group patients, dopaminergic medication was initiated, and the dose was increased to improve motor symptoms. For the chronic medication group patients, dopaminergic medication was adjusted to relieve clinical problems. All participants were tested prior to and at 4–7 months after the drug initiation/adjustment. Executive function was assessed by using the Behavioral Assessment of the Dysexecutive Syndrome (BADS). Motor function was assessed by using the Unified Parkinson’s Disease Rating Scale (UPDRS; part III). Improvement in executive function was compared with a simultaneous change in levodopa equivalent doses (LED) of dopaminergic medication and with improvement in motor functions. Results: The mean standardized BADS scores showed no significant improvement in both the groups. In the de novo group, percent improvement in the standardized BADS scores showed a significant positive correlation with the LED, but not with percent improvement in UPDRS part III. In the chronic medication group, percent improvement in the standardized BADS scores was negatively correlated with change in the LED, but not with percent improvement in UPDRS part III. Multiple regression analysis using improvement in the standardized BADS score as a dependent variable and patient’s background factors (ie, age, education, disease duration, and motor and executive assessments at baseline) as independent variable showed that improvement in the executive assessment is significantly correlated with the LED only in the de novo group. Conclusion: Effects of dopaminergic drug adjustment on executive function differ according to the patient’s clinical stage and depend on LED in de novo stage. Keywords: motor disorders, dopaminergic drug, levodopa equivalent dose, correlation between executive improvement and levodopa equivalent dose, inverted U-shaped theor